“Burdensome, irrelevant, repetitive, not meaningful…detracts from client care.” These are some of the ways addiction counselors describe the collection and use of data in clinical practice. But with addiction treatment entering an era in which collecting and using data is going to become essential for agency survival, staff at all levels of treatment organizations will need to learn to embrace data and the information it can provide.
Ask an Expert: Dr. Jay Ford
Dr. Jay Ford, Director of Research at NIATx (formerly the Network for the Improvement of Addiction Treatment) has conducted research on how organizations use data to guide organizational change. He was part of a team that developed the NIATx model of process improvement, which encourages data-driven decision-making. He’s also studied the role that technology increasingly plays in facilitating the use of data. Dr. Ford addressed some of the issues related to collecting and using data in a recent interview.
Q: What are the biggest barriers to good use and collection of data in addiction treatment organizations?
JF: The number one barrier is that using data to make decisions is not or does not seem to be a priority in the organization. If leadership doesn’t see the role that data can play to support and inform decisions related to clinical care, then it’s less likely that counselors and other staff are going to value and use data.
What’s sometimes overlooked is that data provides essential information that helps organizations keep their doors open. Putting systems in place to monitor new clinical practices, collecting feedback on how successful they are, and acting on that knowledge are all activities associated with successful sustainability. In our research, we have found that effective monitoring through data collection is essential to maintaining improvements and new practices.
Another significant barrier in some organizations is the perception among counselors that data takes away essential time for providing effective treatment. Organizations need to take steps to get counselors comfortable with using data and understanding why it’s important, and how it can actually increase efficiency, and how it relates to the overall mission of the organization. An organizational culture that doesn’t value data will have to work hard to convince counselors that data is their friend. Data and the valuable information it provides really should be embraced rather than viewed as a burdensome requirement that’s robbing counselors of valuable time with their clients.
Organizations can take the approach of showing staff how using data to document quality and successful outcomes is tied to job security. Keep staff informed about your payers’ need to know that the organization is providing quality service. Data that demonstrates better outcomes can have an impact on staff benefits, salaries, job security and expansion of services. Demonstrating the value of data to staff in real-world applications may help increase their buy-in to actively participate in data collection activities.
There’s also a fear of technology—but if it’s set up correctly, technology can help overcome counselors’ fear that data collection is going to be burdensome. Think of what’s happening in primary care offices these days. Many primary care physicians and their staff use some kind of an electronic health record to manage care for their patients. While these systems have an initial learning curve, in the long term they’re improving efficiency, reducing paperwork, and enhancing communication. Multiple staff can have instant access to the latest information on an individual’s record.
Q: Why is data more important now?
JF: Payers are beginning to request data that ties their investment to quality outcomes. Without a way to report on those outcomes, addiction treatment providers will be at a competitive disadvantage. A provider in California told me the Health Information Exchanges present a new opportunity for them to provide care for different populations. As a result of that they realize that they are going to have to show that the services they provide result in quality outcomes.
Similarly, as employers begin to focus more on managing their health care costs, they are going to demand the same level of quality for the services that they are paying for. When I worked for the Baptist Healthcare System in Memphis, Tennessee, major employers in the area such as Federal Express, Buckman Labs, and Rhodes College formed the Memphis Business Group on Health (http://www.memphisbusinessgroup.org/) to “work together to support and influence healthcare services in the Memphis area”. At that time, discussions often centered on the cost and quality of care, with the major healthcare systems competing for their business. For example, Rhodes College recently turned to the MBGH to help expand employee behavioral health benefits (http://www.memphisbusinessgroup.org/successstories). Other cities have similar groups.
As more people obtain insurance coverage, behavioral health providers will be placed in a position to compete for services, not only from the new HIE but also, I believe eventually from local business coalitions similar to the Memphis Business Group on Health.
Hospitals provide report cards on many procedures, and are being penalized if they fall outside of the expected norm. I think that level of scrutiny will migrate into the addictions treatment field, especially as care becomes more integrated.
Some organizations are developing report cards on counselor performance. One of the Promising Practices in the NIATx “tool kit” is “Give Counselors Regular Feedback on No-show and Continuation Rates.” It has examples from two agencies that used data to create counselor “report cards” on client attendance and other rates.
For all these reasons, making data a priority and creating a good system for collecting and managing date is important for addiction treatment organization in today’s changing environment.
Q: What is the easiest way to get a data system in place?
JF: It doesn’t have to be complex, and you don’t have to go out and buy expensive software
or an integrated electronic medical record. You can start with just pencil and paper, or if you have a system, see what reports are available in the system that you already have. It’s important that these are reports that can be generated in real time.
Today, if you have electronic banking and make a purchase, you then see it debited from your account almost instantly. Something similar can be available for a counselor who wants to check a daily no-show rate.
Start by identifying key measures that will be incorporated and fed back to people on a regular basis. Organizational measures may be different than counselors’ measures. Organizations may want to measure and monitor overall wait time and financial progress, while counselors may want to track client no-show rates, units of services, and completion rates.
These systems to track outcomes and provide feedback don’t have to be complex, but they do need to be in real time or as close to real time as possible. While you can have a lot of measures in the system, consider the key elements that you would want to show off in an organizational report card related to key outcomes measures. HEDIS measures is one place to start including measures related to “Follow-Up After Hospitalization for Mental Illness” and “Initiation and Engagement of Alcohol and Other Drug Dependence Treatment.” These measures are sometimes a key part of CARF or Joint Commission accreditation.
Another expert insight: NIATx Coach Janet Bardossi
Janet Bardossi was involved with one of the first organizations to test the NIATx model in 2003, as part of the Paths to Recovery Project, funded by the Robert Wood Johnson Foundation. Over the past decade, she has worked on a variety of improvement projects as a NIATx coach.
“Working with too much data or trying to make it too perfect can be a deterrent to staff and agency engagement in the data process,” says Bardossi. She advises picking the top “X” number of indicators that can improve treatment and concentrate on looking at just those.
“Define the indicators, identify how the data will be pulled, identify who will pull it and how it will be analyzed (it’s best done as a group activity) and finally determine who will follow up on problems and acknowledge people who are doing well.”
Certainly, creating agency cultures supportive of data, helping staff learn to interpret and use data to improve clinical practice, and implementing other data-supportive measures such as those outlined in this article are precursors to being able to remain both effective and competitive in the emerging health care system.
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Janet Bardossi, LCSW and Wendy Hausotter, MPH from Northwest Addiction Technology Transfer Center will discuss:
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