Factors Increasing the Likelihood a Treatment Organziation will Use NIATx

• Organization size (FTE) — a one-unit increase in the measure of organizational size was associated with a 60% increase in the odds of NIATx usage;
• Administrative intensity (ratio of admin staff to total staff) — a standard deviation change in administrative intensity was associated with a 49% increase in the odds of using NIATx;
• Membership in a provider association — programs that were members of provider associations were 1.7 times more likely to use NIATx;
• Participation in the CTN — CTN-affiliated programs were more than twice as likely than non-CTN-programs to use NIATx processes;
• Level of slack resources (ratio of FTEs per patient) — a one-unit increase in slack resources was associated with a 24% decrease in the odds of having used NIATx processes.

Internal process improvement strategies from the Network for Improvement of Addiction Treatment (NIATx) program are promising innovations for improving substance use disorder (SUD) treatment performance, such as engagement and retention. NIATx is designed to engage SUD treatment centers in process improvement by targeting highly specific outcomes, such as reduced days between first patient contact to entrance into treatment, reduced “no show” rates, and enhanced retention in care.

The evidence supporting NIATx’s impact is impressive, however, to date, few studies have examined the variables that may increase diffusion and implementation of NIATx innovations. This article reports on an investigation of organizational characteristics associated with SUD treatment center utilization of NIATx process improvements in a sample of 458 treatment programs participating in the National Treatment Center Study, including programs participating in NIDA’s National Drug Abuse Treatment Clinical Trials Network (CTN).

Overall, 19% of the participating organizations had implemented NIATx process improvements. Five organizational variables were associated with the likelihood centers were using NIATx:

• Organization size (FTE) — a one-unit increase in the measure of organizational size was associated with a 60% increase in the odds of NIATx usage;
• Administrative intensity (ratio of admin staff to total staff) — a standard deviation change in administrative intensity was associated with a 49% increase in the odds of using NIATx;
• Membership in a provider association — programs that were members of provider associations were 1.7 times more likely to use NIATx;
• Participation in the CTN — CTN-affiliated programs were more than twice as likely than non-CTN-programs to use NIATx processes;
• Level of slack resources (ratio of FTEs per patient) — a one-unit increase in slack resources was associated with a 24% decrease in the odds of having used NIATx processes.

Conclusions: From a practical perspective, this study illustrates that the willingness of treatment centers to undertake process improvements through NIATx can be explained to a large extent by organizational factors. Policies and related supportive efforts may be required to facilitate diffusion and implementation of NIATx processes to affect SUD treatment center performance and capacity.