Evidence-Based Management

Creating value for participants in multi-stakeholder alliances: the shifting importance of leadership and collaborative decision-making over time

Creating value for participants in multi-stakeholder alliances: the shifting importance of leadership and collaborative decision-making over time
December 2015. Health Care Management Review.

D'Aunno, T., Alexander, J.A., & Jiang, L.
05/26/2016

BACKGROUND:

Multistakeholder alliances that bring together diverse organizations to work on health-related issues are playing an increasingly prominent role in the U.S. health care system. Prior research shows that collaborative decision-making and effective leadership are related to members' perceptions of value for their participation in alliances. Yet, we know little about how collaborative decision-making and leadership might matter over time in multistakeholder alliances.

PURPOSE:

The aim of this study was to advance understanding of the role of collaborative decision-making and leadership in individuals' assessments of the benefits and costs of their participation in multistakeholder alliances over time.

METHODS:

We draw on data collected from three rounds of surveys of alliance members (2007-2012) who participated in the Robert Wood Johnson Foundation's Aligning Forces for Quality program.

FINDINGS:

Results from regression analyses indicate that individuals' perceptions of value for their participation in alliances shift over time: Perceived value is higher with collaborative decision-making when alliances are first formed and higher with more effective leadership as time passes after alliance formation.

PRACTICE IMPLICATIONS:

Leaders of multistakeholder alliances may need to vary their behavior over time, shifting their emphasis from inclusive decision-making to task achievement.

Hepatitis C Testing in Substance Use Disorder Treatment: The Role of Program Managers in Adoption of Testing Services

Hepatitis C Testing in Substance Use Disorder Treatment: The Role of Program Managers in Adoption of Testing Services
2016. Substance Abuse Treatment, Prevention, and Policy, 11:13.

Frimpong, J.A. & D'Aunno, T.
05/25/2016

BACKGROUND:

Health care organizations do not adopt best practices as often or quickly as they merit. This gap in the integration of best practices into routine practice remains a significant public health concern. The role of program managers in the adoption of best practices has seldom been investigated.

METHODS:

We investigated the association between characteristics of program managers and the adoption of hepatitis C virus (HCV) testing services in opioid treatment programs (OTPs). Data came from the 2005 (n = 187) and 2011 (n = 196) National Drug Abuse Treatment System Survey (NDATSS). We used multivariate regression models to examine correlates of the adoption of HCV testing. We included covariates describing program manager characteristics, such as their race/ethnicity, education, and their sources of information about developments in the field of substance use disorder treatment. We also controlled for characteristics of OTPs and the client populations they serve.

RESULTS:

Program managers were predominantly white and female. A large proportion of program managers had post-graduate education. Program managers expressed strong support for preventive services, but they reported making limited use of available sources of information about developments in the field of substance use disorder (SUD) treatment. The provision of any HCV testing (either on-site or off-site) in OTPs was positively associated with the extent to which a program manager was supportive of preventive services. Among OTPs offering any HCV testing to their clients, on-site HCV testing was more common among programs with an African American manager. It was also more common when program managers relied on a variety of information sources about developments in SUD treatment.

CONCLUSIONS:

Various characteristics of program managers are associated with the adoption of HCV testing in OTPs. Promoting diversity among program managers, and increasing managers' access to information about developments in SUD treatment, may help foster the adoption of best practices.

On-site Bundled Rapid HIV/HCV Testing in Substance Use Disorder Treatment Programs: Study Protocol for a Hybrid Design Randomized Controlled Trial

On-site Bundled Rapid HIV/HCV Testing in Substance Use Disorder Treatment Programs: Study Protocol for a Hybrid Design Randomized Controlled Trial
2016, March 3. Trials, published online.

Frimpong, J.A., D'Aunno, T., Perlman, D.C., Strauss, S.M., Mallow, A., Hernandez, D., Schackman, B.R., Feaster, D.J., & Metsch, L.R.
05/25/2016

Background

More than 1.2 million people in the United States are living with human immunodeficiency virus (HIV), and 3.2 million are living with hepatitis C virus (HCV). An estimated 25 % of persons living with HIV also have HCV. It is therefore of great public health importance to ensure the prompt diagnosis of both HIV and HCV in populations that have the highest prevalence of both infections, including individuals with substance use disorders (SUD).

Methods/design

In this theory-driven, efficacy-effectiveness-implementation hybrid study, we will develop and test an on-site bundled rapid HIV/HCV testing intervention for SUD treatment programs. Its aim is to increase the receipt of HIV and HCV test results among SUD treatment patients. Using a rigorous process involving patients, providers, and program managers, we will incorporate rapid HCV testing into evidence-based HIV testing and linkage to care interventions. We will then test, in a randomized controlled trial, the extent to which this bundled rapid HIV/HCV testing approach increases receipt of HIV and HCV test results. Lastly, we will conduct formative research to understand the barriers to, and facilitators of, the adoption, implementation, and sustainability of the bundled rapid testing strategy in SUD treatment programs.

Discussion

Novel approaches that effectively integrate on-site rapid HIV and rapid HCV testing are needed to address both the HIV and HCV epidemics. If feasible and efficacious, bundled rapid HIV/HCV testing may offer a scalable, potentially cost-effective approach to testing high-risk populations, such as patients of SUD treatment programs. It may ultimately lead to improved linkage to care and progress through the HIV and HCV care and treatment cascades.

What Passes and Fails as Health Policy and Management

What Passes and Fails as Health Policy and Management
Journal of Health Politics, Policy and Law; 39 (5): 1113-1126. doi: 10.1215/03616878-2813719

Rodwin, VG. and Chinitz, DP.
07/18/2014

The field of health policy and management (HPAM) faces a gap between theory, policy and practice. Despite decades of efforts at reforming health policy and health care systems, prominent analysts state that the health system is ‘‘stuck’’ and that models for change remain ‘‘aspirational.’’ We discuss four reasons for the failure of current ideas and models for redesigning health care: (1) the dominance of microeconomic thinking; (2) the lack of comparative studies of health care organizations and the limits of health management theory in recognizing the importance of local contexts; (3) the separation of HPAM from the rank and file of health care, particularly physicians; and (4) the failure to expose medical students to issues of HPAM. We conclude with suggestions for rethinking how the field of HPAM might generate more promising policies for health care providers and managers by abandoning the illusion of context-free theories and, instead, seeking to facilitate the processes by which organizations can learn to improve their own performance.

Evidence-based treatment for opioid disorders: A 23-year national study of methadone dose levels

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

D’Aunno, T., Pollack, H.A., Frimpong, J.A. & Wuchiett, D.
06/10/2014

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.

Adoption of evidence-based clinical innovations: The case of buprenorphine use by opioid treatment programs.

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.

Andrews, C., D’Aunno, T, Friedmann, P.D. & Pollack, H.A.
02/18/2014

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.

Evidence-Based Management: Implications for Nonprofit Organizations

Evidence-Based Management: Implications for Nonprofit Organizations
Nonprofit Management and Leadership, Spring 2014, 24(3): 417–424. doi: 10.1002/nml.21097

Kovner, A. R.
01/09/2014

The article reviews evidence-based management and its implications for practice and teaching. My focus is on strategic decision making in nonprofit organizations. Evidence-based management is a process that includes framing the question, finding evidence, assuring accuracy, applicability, and actionability of evidence until the evidence is the best available.

Child Passenger Safety Laws in the United States, 1978–2010: Policy Diffusion in the Absence of Strong Federal Intervention

Child Passenger Safety Laws in the United States, 1978–2010: Policy Diffusion in the Absence of Strong Federal Intervention
Social Science & Medicine, Vol. 100 (Jan 2014), pp. 30-37. doi:10.1016/j.socscimed.2013.10.035

Bae, J.Y., E. Anderson, D. Silver, and J. Macinko
01/01/2014

This article examines the diffusion of U.S. state child passenger safety laws, analyzing over-time changes and inter-state differences in all identifiable features of laws that plausibly influence crash-related morbidity and mortality. The observed trend shows many states' continuing efforts to update their laws to be consistent with latest motor vehicle safety recommendations, with each state modifying their laws on average 6 times over the 30-year period. However, there has been a considerable time lag in knowledge diffusion and policy adoption. Even though empirical evidence supporting the protective effect of child restraint devices was available in the early 1970s, laws requiring their use were not adopted by all 50 states until 1986. For laws requiring minors to be seated in rear seats, the first state law adoption did not occur until two decades after the evidence became publicly available. As of 2010, only 12 states explicitly required the use of booster seats, 9 for infant seats and 6 for toddler seats. There is also great variation among states in defining the child population to be covered by the laws, the vehicle operators subject to compliance, and the penalties resulting from non-compliance. Some states cover only up to 4-year-olds while others cover children up to age 17. As of 2010, states have as many as 14 exemptions, such as those for non-residents, non-parents, commercial vehicles, large vehicles, or vehicles without seatbelts. Factors such as the complexity of the state of the science, the changing nature of guidelines (from age to height/weight-related criteria), and the absence of coordinated federal actions are potential explanations for the observed patterns. The resulting uneven policy landscape among states suggests a strong need for improved communication among state legislators, public health researchers, advocates and concerned citizen groups to promote more efficient and effective policymaking.

Training Your Own: The Impact of New York City’s Aspiring Principals Program on Achievement

Training Your Own: The Impact of New York City’s Aspiring Principals Program on Achievement
Educational Evaluation and Policy Analysis, 34(2): 232-253.

Corcoran, S. P., Schwartz, A. E., & Weinstein
09/13/2013

The New York City Leadership Academy represents a unique experiment by a large urban school district to train and develop its own school leaders. Its 14-month Aspiring Principals Program (APP) selects and prepares aspiring principals to lead low-performing schools. This study provides the first systematic evaluation of achievement in APP-staffed schools after 3 or more years. We examine differences between APP principals and those advancing through other routes, the extent to which APP graduates serve and remain in schools, and their relative performance in mathematics and English language arts. On balance, we find that APP principals performed about as well as other new principals. If anything, they narrowed the gap with comparison schools in English language arts but lagged behind in mathematics.

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