Thomas D'Aunno

Professor of Management; Director of the Master in Health Administration and Health Policy & Management Program

Thomas D'Aunno

Thomas D'Aunno is Professor of Management at NYU’s Robert F. Wagner Graduate School of Public Service and Director of the Master in Health Administration (MHA) program and the Health Policy and Management Program. D’Aunno’s research and teaching focus on the organization and management of healthcare 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 conducting a study of the organization and performance of Accountable Care Organizations, and he continues his research on the nation's substance abuse treatment system, with a particular focus on treatment for opioid use disorders. 

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, Annals of the Academy of Management, the Journal of the American Medical Association, Health Affairs, and the Journal of Health and Social Behavior.  He served as Editor-in-Chief of Medical Care Research and Review, 2014-2018.  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 from the University of Michigan, Ann Arbor.

This course focuses on the three sets of key questions: (1) mission and vision ("What areas or activities should we be working in?"); (2) strategy and operations ("How can we perform effectively in this area?"); and (3) leadership (“What leadership skills are needed to develop and implement strategies effectively?”).  We will cover both strategy formulation ("What should our strategy be?") and strategy implementation ("What do we need to do to make this strategy work?"). 

All organizations – government agencies as well as non-profit or private companies with a public purpose – face substantial challenges that demand strategic responses, often in uncertain economic, social, or political contexts.  To deal effectively with these challenges, managers need knowledge and skills in strategic management and leadership:  setting and aligning goals with the organization’s mission; handling complex trade-offs between demand for services and resource constraints; defining measures of success; motivating staff and other stakeholders; developing relationships with relevant groups; dealing with crises and environments in transition; and leading organizational change.  In short, the course emphasizes the multiple, related requirements of the leader/manager's job: analysis, creativity, and action.

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Required for M.P.A. (health) students.

This course is intended for graduate students and is about learning how to manage in health care organizations (HCOs).

At the end of this course, students will understand:
• Use of evidence-based management in health care.
• How health services are governed and organized, particularly in non-profit organizations.
• How health care organizations assess and adapt to change.
• How performance control systems work in HCOs.
• Constraints/opportunities in shaping organizational performance and managerial careers.

Students will also learn to work better with others on team projects, and improve their critical thinking and written and oral communication skills.
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This course focuses on the three sets of key questions: (1) mission and vision ("What areas or activities should we be working in?"); (2) strategy and operations ("How can we perform effectively in this area?"); and (3) leadership (“What leadership skills are needed to develop and implement strategies effectively?”).  We will cover both strategy formulation ("What should our strategy be?") and strategy implementation ("What do we need to do to make this strategy work?"). 

All organizations – government agencies as well as non-profit or private companies with a public purpose – face substantial challenges that demand strategic responses, often in uncertain economic, social, or political contexts.  To deal effectively with these challenges, managers need knowledge and skills in strategic management and leadership:  setting and aligning goals with the organization’s mission; handling complex trade-offs between demand for services and resource constraints; defining measures of success; motivating staff and other stakeholders; developing relationships with relevant groups; dealing with crises and environments in transition; and leading organizational change.  In short, the course emphasizes the multiple, related requirements of the leader/manager's job: analysis, creativity, and action.

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In order to utilize teams with the desired result, attention must be paid to how and why teams are assembled, launched, managed and rewarded. This course is also designed to prepare students for their Capstone project teams. This two-day course provides the fundamental principles and methods required to create high performing work, project, Capstone, and/or problem-solving teams. Topics covered will include: moving from group to team; stages of team development; identifying the key competencies for successful team functioning; critical roles and responsibilities on a team; ensuring team productivity; and troubleshooting common team problems. Particular attention will be paid to the critical success factors of Capstone teams - a unique type of team that has its own special challenges.

NOTE: In order to apply course concepts immediately, students form teams to complete the final assignment which is due 2-3 weeks after the course ends.

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This course is designed to study how to manage in and lead health care organizations (HCOs). Topics covered will include: the use of evidence-based management in health care, how health services are governed and organized, particularly in non-profit organizations, how performance control systems work in health care organizations, management of acute and chronic care delivery systems, and models of accountable health care systems.

Download Syllabus

This course focuses on the three sets of key questions: (1) mission and vision ("What areas or activities should we be working in?"); (2) strategy and operations ("How can we perform effectively in this area?"); and (3) leadership (“What leadership skills are needed to develop and implement strategies effectively?”).  We will cover both strategy formulation ("What should our strategy be?") and strategy implementation ("What do we need to do to make this strategy work?"). 

All organizations – government agencies as well as non-profit or private companies with a public purpose – face substantial challenges that demand strategic responses, often in uncertain economic, social, or political contexts.  To deal effectively with these challenges, managers need knowledge and skills in strategic management and leadership:  setting and aligning goals with the organization’s mission; handling complex trade-offs between demand for services and resource constraints; defining measures of success; motivating staff and other stakeholders; developing relationships with relevant groups; dealing with crises and environments in transition; and leading organizational change.  In short, the course emphasizes the multiple, related requirements of the leader/manager's job: analysis, creativity, and action.

Download Syllabus

This course is designed to study how to manage in and lead health care organizations (HCOs). Topics covered will include: the use of evidence-based management in health care, how health services are governed and organized, particularly in non-profit organizations, how performance control systems work in health care organizations, management of acute and chronic care delivery systems, and models of accountable health care systems.

Download Syllabus

This course focuses on the three sets of key questions: (1) mission and vision ("What areas or activities should we be working in?"); (2) strategy and operations ("How can we perform effectively in this area?"); and (3) leadership (“What leadership skills are needed to develop and implement strategies effectively?”).  We will cover both strategy formulation ("What should our strategy be?") and strategy implementation ("What do we need to do to make this strategy work?"). 

All organizations – government agencies as well as non-profit or private companies with a public purpose – face substantial challenges that demand strategic responses, often in uncertain economic, social, or political contexts.  To deal effectively with these challenges, managers need knowledge and skills in strategic management and leadership:  setting and aligning goals with the organization’s mission; handling complex trade-offs between demand for services and resource constraints; defining measures of success; motivating staff and other stakeholders; developing relationships with relevant groups; dealing with crises and environments in transition; and leading organizational change.  In short, the course emphasizes the multiple, related requirements of the leader/manager's job: analysis, creativity, and action.

Download Syllabus

This course focuses on the three sets of key questions: (1) mission and vision ("What areas or activities should we be working in?"); (2) strategy and operations ("How can we perform effectively in this area?"); and (3) leadership (“What leadership skills are needed to develop and implement strategies effectively?”).  We will cover both strategy formulation ("What should our strategy be?") and strategy implementation ("What do we need to do to make this strategy work?"). 

All organizations – government agencies as well as non-profit or private companies with a public purpose – face substantial challenges that demand strategic responses, often in uncertain economic, social, or political contexts.  To deal effectively with these challenges, managers need knowledge and skills in strategic management and leadership:  setting and aligning goals with the organization’s mission; handling complex trade-offs between demand for services and resource constraints; defining measures of success; motivating staff and other stakeholders; developing relationships with relevant groups; dealing with crises and environments in transition; and leading organizational change.  In short, the course emphasizes the multiple, related requirements of the leader/manager's job: analysis, creativity, and action.

Download Syllabus
Genevra F. Murray, Thomas D'Aunno, Valerie A. Lewis. Trust, Money, and Power: Lifecycle Dynamics in Alliances between Management Partners and Accountable Care Organizations. Milbank Quarterly (2018).
Forthcoming

2017

Abstract

Behavioral policy to improve health and health care often relies on interventions, such as nudges, which target individual behaviors. But the most promising applications of behavioral insights in this area involve more far-reaching and systemic interventions. In this article, we propose a series of policies inspired by behavioral research that we believe offer the greatest potential for success. These include interventions
to improve health-related behaviors, health insurance access, decisions about insurance plans, end-of-life care, and rates of medical (for example, organ and blood) donation. We conclude with a discussion of new technologies, such as electronic medical records and web- or mobile-based decision apps, which can enhance doctor and patient adherence to best medical practices. These technologies, however, also pose new challenges that can undermine the effectiveness of medical care delivery.
 

A.R. Kovner & T. D'Aunno. Evidence-Based Management in Healthcare: Principles, Cases, and Perspectives. 2nd edition. Chicago: Health Administration Press, 2017.
E. J. Zajac, T. D'Aunno, and L. R. Burns. 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, 7th edition, 2017.
Forthcoming
T. D'Aunno and M.J. Gilmartin. Motivating people. In L. R. Burns, E. Bradley & B. Weiner (eds.), Health care management: A text in organization behavior and theory. New York: Delmar, 7th edition, 2017.
Forthcoming
Abstract

BACKGROUND: Multistakeholder alliances that bring together diverse organizations to work on community-level health issues are playing an increasingly prominent role in the U.S. health care system. Yet, these alliances by their nature are fragile. In particular, low barriers to exit make alliances particularly vulnerable to disruption if key stakeholders leave. What factors are linked to the sustainability of alliances? One way to approach this question is to examine the perceptions of alliance participants, whose on-going involvement in alliances likely will matter much to their sustainability. PURPOSE: This study addresses the question: “Under what conditions do participants in alliances consider that their alliances are well positioned for the future, will perform well over time, and will be able to deal effectively with future challenges?” METHODS: We draw on cross-sectional survey data collected in the summer of 2015 from a total number of 638 participants in 15 alliances that participated in the Robert Wood Johnson Foundation’s Aligning Forces for Quality program. RESULTS: Results from regression analyses indicate that alliance participants are more likely to view their alliances as sustainable when they (a) share a common vision, goals, and strategies for the alliance and (b) perceive that the alliance has performed effectively in the past. PRACTICE IMPLICATIONS: Leaders of multistakeholder alliances may need to ensure that alliances are collective efforts that build success one step at a time: to the extent that participants believe they share a vision and strategies and have had some prior success working together, the more likely they are to view the alliance as sustainable.

Abstract

Any historical assessment of the public health legacy of the Obama administration will have to look favorably at the impact of the Affordable Care Act (ACA; Pub L No. 111–148) on the US response to the opioid epidemic, and its ability to incentivize and assist states in taking action to fight against the epidemic.

Abstract

Objective: To describe changes in characteristics of directors of outpatient opioid agonist treatment (OAT) programs, and to examine the association between directors’ characteristics and low methadone dosage. Data Source: Repeated cross-sectional surveys of OAT programs in the United States from 1995 to 2011. Study Design: We used generalized linear regression models to examine associations between directors’ characteristics and methadone dose, adjusting for program and patient factors. Data Collection: Data were collected through telephone surveys of program directors. Principal Findings: The proportion of OAT programs with an African American director declined over time, from 29 percent in 1995 to 16 percent in 2011. The median percentage of patients in each program receiving <60 mg/day declined significantly, from 48.5 percent in 1995 to 29 percent in 2005 and 23 percent in 2011. Programs with an African American director were significantly more likely to provide low methadone doses than other programs. This association was even stronger in programs with an African American director who served populations with higher percentages of African American patients. Conclusions: Demographic characteristics of OAT program directors (e.g., their race) may play a key role in explaining variations in methadone dosage across programs and patients. Further research should investigate the causal pathways through which directors’ characteristics affect treatment practices. This may lead to new, multifaceted managerial interventions to improve patient outcomes.

2016

Abstract

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.

Abstract

OBJECTIVE: To identify factors that promote the effective performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program. DATA SOURCES/STUDY SETTING: Data come from a convenience sample of 16 Medicare Shared Savings ACOs that were organized around large physician groups. We use claims data from the Center for Medicaid and Medicare Services and data from 60 interviews at three high-performing and three low-performing ACOs. STUDY DESIGN: Explanatory sequential design, using qualitative data to account for patterns observed in quantitative assessment of ACO performance. DATA COLLECTION METHODS: A total of 16 ACOs were first rank-ordered on measures of cost and quality of care; we then selected three high and three low performers for site visits; interview data were content-analyzed. PRINCIPAL FINDINGS: Results identify several factors that distinguish high- from low-performing ACOs: (1) collaboration with hospitals; (2) effective physician group practice prior to ACO engagement; (3) trusted, long-standing physician leaders focused on improving performance; (4) sophisticated use of information systems; (5) effective feedback to physicians; and (6) embedded care coordinators. CONCLUSIONS: Shorter interventions can improve ACO performance-use of embedded care coordinators and local, regional health information systems; timely feedback of performance data. However, longer term interventions are needed to promote physician-hospital collaboration and skills of physician leaders. CMS and other stakeholders need realistic timelines for ACO performance.

Abstract

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.

Abstract

INTRODUCTION:

Rapid HIV testing (RHT) greatly increases the proportion of clients who learn their test results. However, existing studies have not examined the adoption and implementation of RHT in programs treating persons with substance use disorders, one of the population groups at higher risk for HIV infection.

METHODS:

We examined 196 opioid treatment programs (OTPs) using data from the 2011 National Drug Abuse Treatment System Survey (NDATSS). We used logistic regressions to identify client and organizational characteristics of OTPs associated with availability of on-site RHT. We then used zero-inflated negative binomial regressions to measure the association between the availability of RHT on-site and the number of clients tested for HIV.

RESULTS:

Only 31.6% of OTPs offered on-site rapid HIV testing to their clients. Rapid HIV testing was more commonly available on-site in larger, publicly owned and better-staffed OTPs. On the other hand, on-site rapid HIV testing was less common in OTPs that prescribed only buprenorphine as a method of opioid dependence treatment. The availability of rapid HIV testing on-site reduced the likelihood that an OTP did not test any of its clients during the prior year. But on-site availability rapid HIV testing was not otherwise associated with an increased number of clients tested for HIV at an OTP.

CONCLUSIONS:

New strategies are needed to a) promote the adoption of rapid HIV testing on-site in substance use disorder treatment programs and b) encourage substance use disorder treatment providers to offer rapid HIV testing to their clients when it is available.

Abstract

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.

Abstract

BACKGROUND:

Health care professionals, organizations, and policy makers are calling for expansion of the nurse practitioner (NP) workforce in primary care to assure timely access and high-quality care. However, most efforts promoting NP practice have been focused on state level scope of practice regulations, with limited attention to the organizational structures.

PURPOSE:

We examined NP practice environments in primary care organizations and the extent to which they were associated with NP retention measures.

METHODOLOGY:

Data were collected through mail survey of NPs practicing in 163 primary care organizations in Massachusetts in 2012. NP practice environment was measured by the Nurse Practitioner Primary Care Organizational Climate Questionnaire, which has four subscales: Professional Visibility, NP-Administration Relations, NP-Physician Relations, and Independent Practice and Support. Two global items measured job satisfaction and NPs' intent to leave their job. We aggregated NP level data to organization level to attain measures of practice environments. Multilevel logistic regression models were used.

FINDINGS:

NPs rated the relationship between NPs and physicians favorably, contrary to the relationship between NPs and administrators. All subscales measuring NP practice environment had similar influence on the outcome variables. With every unit increase in each standardized subscale score, the odds of job satisfaction factors increased about 20% whereas the odds of intention of turnover decreased about 20%. NPs from organizations with higher mean scores on the NP-Administration subscale had higher satisfaction with their jobs (OR = 1.24, 95% CI [1.12, 1.39]) and had lower intent to leave (OR = 0.79, 95% CI [0.70, 0.90]).

PRACTICE IMPLICATIONS:

NPs were more likely to be satisfied with their jobs and less likely to report intent to leave if their organizations support NP practice, favorable relations with physicians and administration, and clear role visibility. Creating productive practice environments that can retain NPs is a potential strategy for increasing the primary care workforce capacity.

Abstract

BACKGROUND: To examine the extent to which state adoption of the Centers for Disease Control and Prevention (CDC) 2006 revisions to adult and adolescent HIV testing guidelines is associated with availability of other important prevention and medical services. We hypothesized that in states where the pretest counseling requirement for HIV testing was dropped from state legislation, substance use disorder treatment programs would have higher availability of HCV testing services than in states that had maintained this requirement. METHODS: We analyzed a nationally representative sample of 383 opioid treatment programs from the 2005 and 2011 National Drug Abuse Treatment System Survey (NDATSS). Data were collected from program directors and clinical supervisors through telephone surveys. Multivariate logistic regression models were used to measure associations between state adoption of CDC recommended guidelines for HIV pretest counseling and availability of HCV testing services. RESULTS: The effects of HIV testing legislative changes on HCV testing practices varied by type of opioid treatment program. In states that had removed the requirement for HIV pretest counseling, buprenorphine-only programs were more likely to offer HCV testing to their patients. The positive spillover effect of HIV pretest counseling policies, however, did not extend to methadone programs and did not translate into increased availability of on-site HCV testing in either program type. CONCLUSIONS: Our findings highlight potential positive spillover effects of HIV testing policies on HCV testing practices. They also suggest that maximizing the benefits of HIV policies may require other initiatives, including resources and programmatic efforts that support systematic integration with other services and effective implementation. 

2015

Abstract

To meet their aims of managing population health to improve the quality and cost of health care in the United States, accountable care organizations (ACOs) will need to focus on coordinating care for individuals with substance abuse disorders. The prevalence of these disorders is high, and these individuals often suffer from comorbid chronic medical and social conditions. This article examines the extent to which the nation's fourteen thousand specialty substance abuse treatment (SAT) organizations, which have a daily census of more than 1 million patients, are contracting with ACOs across the country; we also examine factors associated with SAT organization involvement with ACOs. We draw on data from a recent (2014) nationally representative survey of executive directors and clinical supervisors from 635 SAT organizations. Results show that only 15 percent of these organizations had signed contracts with ACOs. Results from multivariate analyses show that directors' perceptions of market competition, organizational ownership, and geographic location are significantly related to SAT involvement with ACOs. We discuss implications for integrating the SAT specialty system with the mainstream health care system.

Abstract

BACKGROUND

Members of racial and ethnic minority groups are most likely to experience limited access and poor engagement in addiction treatment. Research has been limited on the role of program capacity and delivery of comprehensive care in improving access and retention among minorities with drug abuse issues. The goal of this study was to examine the extent to which access and retention are enhanced when racial and ethnic minorities receive care from high-capacity addiction health services (AHS) programs and via coordination with mental health and receipt of HIV testing services. Methods: This multilevel cross-sectional analysis involved data from 108 programs merged with client data from 2011 for 13,478 adults entering AHS. Multilevel negative binomial regression models were used to test interactions and indirect relationships between program capacity and days to enter treatment (wait time) and days in treatment (retention).

RESULTS

Compared to low-capacity programs and non-Latino and non-African American clients, Latinos and African Americans served in high-capacity programs reported shorter wait times to admission, as hypothesized. African Americans also had longer treatment retention in high-capacity programs. Receipt of HIV testing and program coordination of mental health services played an indirect role in the relationship between program capacity and wait time.

CONCLUSIONS

Program capacity and coordinated services in AHS may reduce disparities in access to care. Implications for supporting low-capacity programs to eliminate the disparity gap in access to care are discussed.

2014

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.

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.

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.

D’Aunno, T.. 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.
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.

2012

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

Pollack, H. & D’Aunno, T.. 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.
Zajac, E.J., D’Aunno, T.& L.R. Burns.. 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.. 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.

2009

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