Organizational Change to Improve Access and Retention

描述（由申请人提供）： 孤立的努力、小规模的样本和持续时间有限的干预措施阻碍了关于提高药物滥用治疗质量的研究。一项包括近50个药物滥用治疗方案的倡议提供了一个机会，以检查过程改进的纵向应用，并评估组织持续改进过程的能力。罗伯特·伍德约翰逊基金会的康复之路（路径）和药物滥用治疗中心的加强治疗获得和保留（星星）是协调一致的倡议，使用过程改进战略，以提高获得护理和改善护理保留。此建议针对一个主要问题-持续性和普遍性的过程改进后，计划参与完成。参与研究中心将继续报告18个月的访问和保留数据，并继续参与季度访谈和研究中心访视。一个经过验证的组织变革模型（组织变革管理者）指导分析。具体目标（即，评估变更的稳定性，记录最初关注访问和保留之外的推广情况，并确定在计划支持终止后的18个月内有助于可持续性和推广的组织因素）测试3个假设： H1：在18个月的随访期间，项目期间实现的收益（住院天数减少、住院人数增加、继续治疗改善和未就诊人数减少）将保持在稳定的平台期。 H2：将继续使用过程改进，并推广到组织内的其他治疗单位和参与中心内的其他治疗过程。 H3：OCM的六个维度（变革领导者强有力，行政领导参与，员工支持变革，外部想法，环境支持，变革压力）将与持续使用流程改进和持续获得访问和保留的可能性更大。

DESCRIPTION (provided by applicant): Isolated efforts, small sample sizes and interventions with limited duration hamper research on quality improvement for drug abuse treatment. An initiative that includes nearly 50 drug abuse treatment programs provides an opportunity to examine the longitudinal application of process improvement and to assess organizational ability to sustain process improvements. The Robert Wood Johnson Foundation's Paths to Recovery (Paths) and the Center for Substance Abuse Treatment's Strengthening Treatment Access and Retention (STAR) are coordinated initiatives using process improvement strategies to enhance access to care and improve retention in care. This proposal addresses a major issue-sustainability and generalization of process improvement after program participation is finished. Participating sites will continue to report access and retention data for 18 months and continue to participate in quarterly interviews and site visits. A validated model of organizational change (the Organizational Change Manager) guides the analysis. The specific aim (i.e., Assess stability of change, record generalization beyond the initial focus on access and retention, and identify organizational factors that contribute to sutainability and generalization during an 18 month period following termination of program support) tests 3 hypotheses: H1: Gains achieved during the project (reduced days to admission, increased admissions, improved continuation, and reduced no-shows) will be maintained at a stable plateau during 18 months of follow-up. H2: The use of process improvement will continue and generalize to other treatment units within the organization and to other treatment processes within the participating center. H3: Six OCM dimensions (change leader is strong, executive leadership is involved, staff support change, external ideas, environment is supportive, and tension for change) will be associated with a greater likelihood of sustained use of process improvement and sustained gains in access and retention.