Organizational Change to Improve Access and Retention

描述(由申请人提供)： 孤立的努力、小样本量和持续时间有限的干预措施阻碍了提高药物滥用治疗质量的研究。一项包括近50个药物滥用治疗计划的倡议提供了一个机会，以检查过程改进的纵向应用，并评估组织维持过程改进的能力。罗伯特·伍德·约翰逊基金会的康复之路(PATHS)和药物滥用治疗中心的加强治疗获取和保留(STAR)是协调一致的倡议，使用程序改进战略来增加获得护理的机会和改善护理的保留。这项建议解决了一个主要问题--项目参与结束后过程改进的可持续性和普遍性。参与网站将在18个月内继续报告访问和保留数据，并继续参加季度访谈和现场访问。经过验证的组织变更模型(组织变更管理器)指导分析。具体目标(即，评估变化的稳定性、记录推广超越最初对获取和保留的关注，以及在计划支持终止后的18个月期间确定有助于可持续性和推广的组织因素)检验3个假设： H1：项目期间取得的成果(入院天数减少、入院人数增加、续展情况改善、缺席人数减少)将在18个月的后续行动中保持稳定。 过程改进的使用将继续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(变革领导者是强有力的、行政领导参与其中、员工支持变革、外部想法、环境是支持性的、变革的紧张性)将与持续使用过程改进以及在获取和保留方面获得持续收益的可能性更大。

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.