VA residential substance use disorder treatment program providers' perceptions of facilitators and barriers to performance on pre-admission processes.
Identifieur interne : 000867 ( Main/Exploration ); précédent : 000866; suivant : 000868VA residential substance use disorder treatment program providers' perceptions of facilitators and barriers to performance on pre-admission processes.
Auteurs : Laura S. Ellerbe [États-Unis] ; Luisa Manfredi [États-Unis] ; Shalini Gupta [États-Unis] ; Tyler E. Phelps [États-Unis] ; Thomas R. Bowe [États-Unis] ; Anna D. Rubinsky [États-Unis] ; Jennifer L. Burden [États-Unis] ; Alex H S. Harris [États-Unis]Source :
- Addiction science & clinical practice [ 1940-0640 ] ; 2017.
Descripteurs français
- KwdFr :
- Accessibilité des services de santé (statistiques et données numériques), Admission du patient (statistiques et données numériques), Amélioration de la qualité (MeSH), Anciens combattants (statistiques et données numériques), Attitude du personnel soignant (MeSH), Department of Veterans Affairs (USA) (MeSH), Femelle (MeSH), Humains (MeSH), Mâle (MeSH), Qualité des soins de santé (MeSH), Traitement résidentiel (organisation et administration), Troubles liés à une substance (thérapie), États-Unis (MeSH).
- MESH :
- organisation et administration : Traitement résidentiel.
- statistiques et données numériques : Accessibilité des services de santé, Admission du patient, Anciens combattants.
- thérapie : Troubles liés à une substance.
- Amélioration de la qualité, Attitude du personnel soignant, Department of Veterans Affairs (USA), Femelle, Humains, Mâle, Qualité des soins de santé, États-Unis.
English descriptors
- KwdEn :
- Attitude of Health Personnel (MeSH), Female (MeSH), Health Services Accessibility (statistics & numerical data), Humans (MeSH), Male (MeSH), Patient Admission (statistics & numerical data), Quality Improvement (MeSH), Quality of Health Care (MeSH), Residential Treatment (organization & administration), Substance-Related Disorders (therapy), United States (MeSH), United States Department of Veterans Affairs (MeSH), Veterans (statistics & numerical data).
- MESH :
- organization & administration : Residential Treatment.
- statistics & numerical data : Health Services Accessibility, Patient Admission, Veterans.
- therapy : Substance-Related Disorders.
- Attitude of Health Personnel, Female, Humans, Male, Quality Improvement, Quality of Health Care, United States, United States Department of Veterans Affairs.
Abstract
BACKGROUND
In the U.S. Department of Veterans Affairs (VA), residential treatment programs are an important part of the continuum of care for patients with a substance use disorder (SUD). However, a limited number of program-specific measures to identify quality gaps in SUD residential programs exist. This study aimed to: (1) Develop metrics for two pre-admission processes: Wait Time and Engagement While Waiting, and (2) Interview program management and staff about program structures and processes that may contribute to performance on these metrics. The first aim sought to supplement the VA's existing facility-level performance metrics with SUD program-level metrics in order to identify high-value targets for quality improvement. The second aim recognized that not all key processes are reflected in the administrative data, and even when they are, new insight may be gained from viewing these data in the context of day-to-day clinical practice.
METHODS
VA administrative data from fiscal year 2012 were used to calculate pre-admission metrics for 97 programs (63 SUD Residential Rehabilitation Treatment Programs (SUD RRTPs); 34 Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) with a SUD track). Interviews were then conducted with management and front-line staff to learn what factors may have contributed to high or low performance, relative to the national average for their program type. We hypothesized that speaking directly to residential program staff may reveal innovative practices, areas for improvement, and factors that may explain system-wide variability in performance.
RESULTS
Average wait time for admission was 16 days (SUD RRTPs: 17 days; MH RRTPs with a SUD track: 11 days), with 60% of Veterans waiting longer than 7 days. For these Veterans, engagement while waiting occurred in an average of 54% of the waiting weeks (range 3-100% across programs). Fifty-nine interviews representing 44 programs revealed factors perceived to potentially impact performance in these domains. Efficient screening processes, effective patient flow, and available beds were perceived to facilitate shorter wait times, while lack of beds, poor staffing levels, and lengths of stay of existing patients were thought to lengthen wait times. Accessible outpatient services, strong patient outreach, and strong encouragement of pre-admission outpatient treatment emerged as facilitators of engagement while waiting; poor staffing levels, socioeconomic barriers, and low patient motivation were viewed as barriers.
CONCLUSIONS
Metrics for pre-admission processes can be helpful for monitoring residential SUD treatment programs. Interviewing program management and staff about drivers of performance metrics can play a complementary role by identifying innovative and other strong practices, as well as high-value targets for quality improvement. Key facilitators of high-performing facilities may offer programs with lower performance useful strategies to improve specific pre-admission processes.
DOI: 10.1186/s13722-017-0075-z
PubMed: 28372579
PubMed Central: PMC5379682
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Attitude of Health Personnel (MeSH)</term>
<term>Female (MeSH)</term>
<term>Health Services Accessibility (statistics & numerical data)</term>
<term>Humans (MeSH)</term>
<term>Male (MeSH)</term>
<term>Patient Admission (statistics & numerical data)</term>
<term>Quality Improvement (MeSH)</term>
<term>Quality of Health Care (MeSH)</term>
<term>Residential Treatment (organization & administration)</term>
<term>Substance-Related Disorders (therapy)</term>
<term>United States (MeSH)</term>
<term>United States Department of Veterans Affairs (MeSH)</term>
<term>Veterans (statistics & numerical data)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Accessibilité des services de santé (statistiques et données numériques)</term>
<term>Admission du patient (statistiques et données numériques)</term>
<term>Amélioration de la qualité (MeSH)</term>
<term>Anciens combattants (statistiques et données numériques)</term>
<term>Attitude du personnel soignant (MeSH)</term>
<term>Department of Veterans Affairs (USA) (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Mâle (MeSH)</term>
<term>Qualité des soins de santé (MeSH)</term>
<term>Traitement résidentiel (organisation et administration)</term>
<term>Troubles liés à une substance (thérapie)</term>
<term>États-Unis (MeSH)</term>
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<keywords scheme="MESH" qualifier="organisation et administration" xml:lang="fr"><term>Traitement résidentiel</term>
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<keywords scheme="MESH" qualifier="organization & administration" xml:lang="en"><term>Residential Treatment</term>
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<keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Health Services Accessibility</term>
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<term>Veterans</term>
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<term>Admission du patient</term>
<term>Anciens combattants</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Substance-Related Disorders</term>
</keywords>
<keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>Troubles liés à une substance</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Attitude of Health Personnel</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Quality Improvement</term>
<term>Quality of Health Care</term>
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<term>United States Department of Veterans Affairs</term>
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<term>Department of Veterans Affairs (USA)</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>In the U.S. Department of Veterans Affairs (VA), residential treatment programs are an important part of the continuum of care for patients with a substance use disorder (SUD). However, a limited number of program-specific measures to identify quality gaps in SUD residential programs exist. This study aimed to: (1) Develop metrics for two pre-admission processes: Wait Time and Engagement While Waiting, and (2) Interview program management and staff about program structures and processes that may contribute to performance on these metrics. The first aim sought to supplement the VA's existing facility-level performance metrics with SUD program-level metrics in order to identify high-value targets for quality improvement. The second aim recognized that not all key processes are reflected in the administrative data, and even when they are, new insight may be gained from viewing these data in the context of day-to-day clinical practice.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>VA administrative data from fiscal year 2012 were used to calculate pre-admission metrics for 97 programs (63 SUD Residential Rehabilitation Treatment Programs (SUD RRTPs); 34 Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) with a SUD track). Interviews were then conducted with management and front-line staff to learn what factors may have contributed to high or low performance, relative to the national average for their program type. We hypothesized that speaking directly to residential program staff may reveal innovative practices, areas for improvement, and factors that may explain system-wide variability in performance.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>Average wait time for admission was 16 days (SUD RRTPs: 17 days; MH RRTPs with a SUD track: 11 days), with 60% of Veterans waiting longer than 7 days. For these Veterans, engagement while waiting occurred in an average of 54% of the waiting weeks (range 3-100% across programs). Fifty-nine interviews representing 44 programs revealed factors perceived to potentially impact performance in these domains. Efficient screening processes, effective patient flow, and available beds were perceived to facilitate shorter wait times, while lack of beds, poor staffing levels, and lengths of stay of existing patients were thought to lengthen wait times. Accessible outpatient services, strong patient outreach, and strong encouragement of pre-admission outpatient treatment emerged as facilitators of engagement while waiting; poor staffing levels, socioeconomic barriers, and low patient motivation were viewed as barriers.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>Metrics for pre-admission processes can be helpful for monitoring residential SUD treatment programs. Interviewing program management and staff about drivers of performance metrics can play a complementary role by identifying innovative and other strong practices, as well as high-value targets for quality improvement. Key facilitators of high-performing facilities may offer programs with lower performance useful strategies to improve specific pre-admission processes.</p>
</div>
</front>
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<DateCompleted><Year>2017</Year>
<Month>11</Month>
<Day>28</Day>
</DateCompleted>
<DateRevised><Year>2018</Year>
<Month>11</Month>
<Day>13</Day>
</DateRevised>
<Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1940-0640</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>12</Volume>
<Issue>1</Issue>
<PubDate><Year>2017</Year>
<Month>04</Month>
<Day>04</Day>
</PubDate>
</JournalIssue>
<Title>Addiction science & clinical practice</Title>
<ISOAbbreviation>Addict Sci Clin Pract</ISOAbbreviation>
</Journal>
<ArticleTitle>VA residential substance use disorder treatment program providers' perceptions of facilitators and barriers to performance on pre-admission processes.</ArticleTitle>
<Pagination><MedlinePgn>10</MedlinePgn>
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<ELocationID EIdType="doi" ValidYN="Y">10.1186/s13722-017-0075-z</ELocationID>
<Abstract><AbstractText Label="BACKGROUND">In the U.S. Department of Veterans Affairs (VA), residential treatment programs are an important part of the continuum of care for patients with a substance use disorder (SUD). However, a limited number of program-specific measures to identify quality gaps in SUD residential programs exist. This study aimed to: (1) Develop metrics for two pre-admission processes: Wait Time and Engagement While Waiting, and (2) Interview program management and staff about program structures and processes that may contribute to performance on these metrics. The first aim sought to supplement the VA's existing facility-level performance metrics with SUD program-level metrics in order to identify high-value targets for quality improvement. The second aim recognized that not all key processes are reflected in the administrative data, and even when they are, new insight may be gained from viewing these data in the context of day-to-day clinical practice.</AbstractText>
<AbstractText Label="METHODS">VA administrative data from fiscal year 2012 were used to calculate pre-admission metrics for 97 programs (63 SUD Residential Rehabilitation Treatment Programs (SUD RRTPs); 34 Mental Health Residential Rehabilitation Treatment Programs (MH RRTPs) with a SUD track). Interviews were then conducted with management and front-line staff to learn what factors may have contributed to high or low performance, relative to the national average for their program type. We hypothesized that speaking directly to residential program staff may reveal innovative practices, areas for improvement, and factors that may explain system-wide variability in performance.</AbstractText>
<AbstractText Label="RESULTS">Average wait time for admission was 16 days (SUD RRTPs: 17 days; MH RRTPs with a SUD track: 11 days), with 60% of Veterans waiting longer than 7 days. For these Veterans, engagement while waiting occurred in an average of 54% of the waiting weeks (range 3-100% across programs). Fifty-nine interviews representing 44 programs revealed factors perceived to potentially impact performance in these domains. Efficient screening processes, effective patient flow, and available beds were perceived to facilitate shorter wait times, while lack of beds, poor staffing levels, and lengths of stay of existing patients were thought to lengthen wait times. Accessible outpatient services, strong patient outreach, and strong encouragement of pre-admission outpatient treatment emerged as facilitators of engagement while waiting; poor staffing levels, socioeconomic barriers, and low patient motivation were viewed as barriers.</AbstractText>
<AbstractText Label="CONCLUSIONS">Metrics for pre-admission processes can be helpful for monitoring residential SUD treatment programs. Interviewing program management and staff about drivers of performance metrics can play a complementary role by identifying innovative and other strong practices, as well as high-value targets for quality improvement. Key facilitators of high-performing facilities may offer programs with lower performance useful strategies to improve specific pre-admission processes.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Ellerbe</LastName>
<ForeName>Laura S</ForeName>
<Initials>LS</Initials>
<AffiliationInfo><Affiliation>Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Manfredi</LastName>
<ForeName>Luisa</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA. Luisa.Manfredi@va.gov.</Affiliation>
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<Initials>AD</Initials>
<AffiliationInfo><Affiliation>Department of Medicine, University of California, San Francisco and the San Francisco VA Medical Center, San Francisco, CA, USA.</Affiliation>
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<AffiliationInfo><Affiliation>Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA.</Affiliation>
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<name sortKey="Bowe, Thomas R" sort="Bowe, Thomas R" uniqKey="Bowe T" first="Thomas R" last="Bowe">Thomas R. Bowe</name>
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<name sortKey="Gupta, Shalini" sort="Gupta, Shalini" uniqKey="Gupta S" first="Shalini" last="Gupta">Shalini Gupta</name>
<name sortKey="Harris, Alex H S" sort="Harris, Alex H S" uniqKey="Harris A" first="Alex H S" last="Harris">Alex H S. Harris</name>
<name sortKey="Manfredi, Luisa" sort="Manfredi, Luisa" uniqKey="Manfredi L" first="Luisa" last="Manfredi">Luisa Manfredi</name>
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