Thomas D'Aunno

Thomas D'Aunno
Professor of Management

Thomas D'Aunno is Professor of Management at NYU’s Robert F. Wagner Graduate School of Public Service, and Chair of Health Policy and Management at the Global Institute of Public Health. D’Aunno’s research and teaching focus on the organization and management of health care services: he has a particular interest in the diffusion and adoption of evidence-based practices and leadership and organizational change. He has examined these issues in a variety of national studies funded by the National Institutes of Health and the Agency for Health Care Quality and Research. He is currently leading a study of the organization and performance of Accountable Care Organizations.

D’Aunno was previously a faculty member at Columbia University, the University of Chicago, the University of Michigan, and INSEAD, where he held the Novartis Chair in Healthcare Management. He is published in leading management and health journals, including Administrative Science Quarterly, the Academy of Management Journal, Academy of Management Review, the Journal of the American Medical Association, and the Journal of Health and Social Behavior. In 2014, he became the Editor-in-Chief of Medical Care Research and Review. He also is a past chairman of the Academy of Management Division of Health Care Management and a recipient of their award for career distinguished service.

D’Aunno graduated Magna Cum Laude with a B.A. in Psychology from the University of Notre Dame and received his Ph.D. in Organizational Psychology at the University of Michigan, Ann Arbor.

Date Publication/Paper
2014

Frimpong, J.A., D’Aunno, T. & Jiang, L. 2014. Determinants of the Availability of Hepatitis C Testing Services in Opioid Treatment Programs: Results From a National Study American Journal of Public Health, 2014 (June), 104(6): 75-82. doi: 10.2105/AJPH.2013.301827
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Abstract

OBJECTIVES: We examined trends and organizational-level correlates of the availability of HCV testing in opioid treatment programs.

METHODS: We used generalized ordered logit models to examine associations between organizational characteristics of 383 opioid treatment programs from the 2005 and 2011 National Drug Abuse Treatment System Survey and HCV testing availability.

RESULTS: Between 2005 and 2011, the proportion of opioid treatment programs offering HCV testing increased but largely because of increases in off-site referrals rather than on-site testing. HCV testing availability was higher in opioid treatment programs affiliated with a hospital and those receiving federal funds. Opioid treatment programs providing both methadone and buprenorphine were more likely to offer any HCV testing, whereas opioid treatment programs providing only buprenorphine treatment were less likely to offer on-site testing. HCV testing availability was associated with more favorable staff-to-client ratios.

CONCLUSIONS: The increasing use of off-site referrals for HCV testing in opioid treatment programs likely limits opportunities for case finding, prevention, and treatment. Declines in federal funding for opioid treatment programs may be a key determinant of the availability of HCV testing in opioid treatment programs.

D’Aunno, T., Pollack, H.A., Frimpong, J.A. & Wuchiett, D. 2014. Evidence-based treatment for opioid disorders: A 23-year national study of methadone dose levels Journal of Substance Abuse Treatment, in press. DOI: 10.1016/j.jsat.2014.06.001
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Abstract

Effective treatment for patients with opioid use problems is as critical as ever given the upsurge in heroin and prescription opioid abuse. Yet, results from prior studies show that the majority of methadone maintenance treatment (MMT) programs in the US have not provided dose levels that meet evidence-based standards. Thus, this paper examines the extent to which US MMT programs have made changes in the past 23 years to provide adequate methadone doses; we also identify factors associated with variation in program performance. Program directors and clinical supervisors of nationally-representative methadone treatment programs were surveyed in 1988 (n = 172), 1990 (n = 140), 1995 (n = 116), 2000 (n = 150), 2005 (n = 146), and 2011 (n = 140). Results show that the proportion of patients who received doses below 60 mg/day—the minimum recommended—declined from 79.5 to 22.8% in a 23-year span. Results from random effects models show that programs that serve a higher proportion of African-American or Hispanic patients were more likely to report low-dose care. Programs with Joint Commission accreditation were more likely to provide higher doses, as were a program that serves a higher proportion of unemployed and older patients. Efforts to improve methadone treatment practices have made substantial progress, but 23% of patients across the nation are still receiving doses that are too low to be effective.

Andrews, C., D’Aunno, T, Friedmann, P.D. & Pollack, H.A. 2014. Adoption of evidence-based clinical innovations: The case of buprenorphine use by opioid treatment programs. Medical Care Research & Review, 2014 (February), 71(1):43-60. doi: 10.1177/1077558713503188. Epub 2013 Sep 18.
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Abstract

This article examines changes from 2005 to 2011 in the use of an evidence-based clinical innovation, buprenorphine use, among a nationally representative sample of opioid treatment programs and identifies characteristics associated with its adoption. We apply a model of the adoption of clinical innovations that focuses on the work needs and characteristics of staff; organizations' technical and social support for the innovation; local market dynamics and competition; and state policies governing the innovation. Results indicate that buprenorphine use increased 24% for detoxification and 47% for maintenance therapy between 2005 and 2011. Buprenorphine use was positively related to reliance on private insurance and availability of state subsidies to cover its cost and inversely related to the percentage of clients who injected opiates, county size, and local availability of methadone. The results indicate that financial incentives and market factors play important roles in opioid treatment programs' decisions to adopt evidence-based clinical innovations such as buprenorphine use.

D’Aunno, T., Pollack, H.A., Jiang, L., Metsch, L.R. & Friedmann, P. D. 2014. HIV testing in the nation’s opioid treatment programs, 2005-2011: The role of state regulations Health Services Research, 2014 (February), 49(1):230-48. DOI: 10.1111/1475-6773.12094
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Abstract

Objective: To identify the extent to which clients in a national sample of opioid treatment programs (OTPs) received HIV testing in 2005 and 2011; to examine relationships between state laws for informed consent and pretest counseling and rates of HIV testing among OTP clients.

Data Source: Data were collected from a nationally representative sample of OTPs in 2005 (n = 171) and 2011 (n = 200).

Study Design: Random-effects logit and interval regression analyses were used to examine changes in HIV testing rates and the relationship of state laws to HIV testing among OTPs.

Data Collection: Data on OTP provision of HIV testing were collected in phone surveys from OTP managers; data also were collected on state laws for HIV testing.

Principal Findings: The percentage of OTPs offering HIV testing decreased significantly from 93 percent in 2005 to 64 percent in 2011. Similarly, the percentage of clients tested decreased from an average of 41 percent in 2005 to 17 percent in 2011. OTPs located in states whose laws do not require pretest counseling and that use opt-out consent were more likely to provide HIV testing and to test higher percentages of clients.

Conclusions: The results show the need to increase HIV testing among OTP clients; the results also underscore the beneficial possibilities of dropping pretest counseling as a requirement for HIV testing and of using the opt-out approach to informed consent for testing.

D’Aunno, T. 2014. Explaining Change in Institutionalized Practices: A Review and Road Map for Research In Stephen S. Mick and Patrick D. Shay (eds.). Advances in Health Care Organizational Theory, 2nd edition. Chapter 4. San Francisco, CA: Wiley/Jossey-Bass, 2014.

2012

Liu, N. & D’Aunno, T. 2012. The productivity and cost-efficiency of models for involving nurse practitioners in primary care: A perspective from queuing analysis. Health Services Research, 47 (2), 2012 Apr:594-613. doi: 10.1111/j.1475-6773.2011.01343.x. Epub 2011 Nov 8.
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Abstract

OBJECTIVE: To develop simple stylized models for evaluating the productivity and cost-efficiencies of different practice models to involve nurse practitioners (NPs) in primary care, and in particular to generate insights on what affects the performance of these models and how.

DATA SOURCES AND STUDY DESIGN: The productivity of a practice model is defined as the maximum number of patients that can be accounted for by the model under a given timeliness-to-care requirement; cost-efficiency is measured by the corresponding annual cost per patient in that model. Appropriate queueing analysis is conducted to generate formulas and values for these two performance measures. Model parameters for the analysis are extracted from the previous literature and survey reports. Sensitivity analysis is conducted to investigate the model performance under different scenarios and to verify the robustness of findings.

PRINCIPAL FINDINGS: Employing an NP, whose salary is usually lower than a primary care physician, may not be cost-efficient, in particular when the NP's capacity is underutilized. Besides provider service rates, workload allocation among providers is one of the most important determinants for the cost-efficiency of a practice model involving NPs. Capacity pooling among providers could be a helpful strategy to improve efficiency in care delivery.

CONCLUSIONS: The productivity and cost-efficiency of a practice model depend heavily on how providers organize their work and a variety of other factors related to the practice environment. Queueing theory provides useful tools to take into account these factors in making strategic decisions on staffing and panel size selection for a practice model.

2010

Zajac, E.J., D’Aunno, T.& L.R. Burns. 2010. Managing strategic alliances In L.R. Burns, E. Bradley & B. Weiner (eds.). Health care management: A text in organization behavior and theory. New York: Delmar, 6th edition, 2010.

D’Aunno, T. & Gilmartin, M. J. 2010. Motivating people In L. R. Burns, E. Bradley & B. Weiner (eds.), Health care management: A text in organization behavior and theory. New York: Delmar, 6th edition, 2010.

Pollack, H. & D’Aunno, T. 2010. HIV testing and counseling in the nation's outpatient substance abuse treatment system, 1995-2005 Journal of Substance Abuse Treatment,38(4): 307-16, 2010.

2009

Battilana, J. & T. D'Aunno 2009. The paradox of embedded agency: Straw-man argument or central epistemological issue? In Institutional Work: A New Agenda for Institutional Studies of Organization, T. Lawrence, R. Suddaby and B. Leca. (eds.) Cambridge, UK: Cambridge University Press, 2009.

2008

Pollack, H.A. & D’Aunno, T. 2008. Dosage patterns in methadone treatment: Results from a national survey, 1988-2005 Health Services Research, December: 2143-2163, 2008.

D’Aunno, T. Kimberly, J.R. & de Pouvourville, G. 2008. The globalization of managerial innovation: Analyzing the diffusion of patient classification systems In Kimberly, J.R, de Pouvourville, G. & D’Aunno T (eds.) The Globalization of Managerial Innovation: Patient Classification Systems in Health Care. Cambridge, UK: Cambridge University Press, 2008.

2007

Gilmartin, M.J. & D’Aunno, T. 2007. Leadership research in healthcare: A review and roadmap Annals of the Academy of Management . Vol 1, (Brief, A & Walsh, J.P (eds.), New Jersey: Lawrence Earlbaum Associates, 2007.

2006

Wells, R.B. Lemak, C.H. & D’Aunno, T. 2006. Insights from a national survey into why substance abuse treatment units add prevention and outreach services Substance Abuse Treatment, Prevention, and Policy 2006, 1:21

D’Aunno, T. 2006. The role of organization and management in substance abuse treatment: Review and roadmap. Journal of Substance Abuse Treatment, 31: 221-233, 2006.