Health Policy

Integration of substance abuse treatment organizations into Accountable Care Organizations: Results from a national survey

Integration of substance abuse treatment organizations into Accountable Care Organizations: Results from a national survey
Journal of Health Politics, Policy and Law 40(4), August 2015.

D'Aunno, T., Friedmann, P.D., Chen, Q., & Wilson, D.M.
05/26/2016

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.

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.

Paths to improving engagement among racial and ethnic minorities in addiction health services

Paths to improving engagement among racial and ethnic minorities in addiction health services
Substance Abuse Treatment, Prevention, & Policy (2015) 10:40.

Guerrero, E., Fenwick, K., Kong, Y., Grella, C., & D'Aunno, T.
05/26/2016

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.

Practice environments and job satisfaction and turnover intentions of nurse practitioners: Implications for primary care workforce capacity

Practice environments and job satisfaction and turnover intentions of nurse practitioners: Implications for primary care workforce capacity
November 2015. Health Care Management Review.

Poghosyan, L., Liu, J., Shang, J., & D'Aunno, T.
05/26/2016

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.

Practice environments and job satisfaction and turnover intentions of nurse practitioners: Implications for primary care workforce capacity

Practice environments and job satisfaction and turnover intentions of nurse practitioners: Implications for primary care workforce capacity
November 2015. Health Care Management Review.

Poghosyan, L., Liu, J., Shang, J., & D'Aunno, T.
05/26/2016

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.

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.

Low Rates of Adoption and Implementation of Rapid HIV Testing in Substance Use Disorder Treatment Programs

Low Rates of Adoption and Implementation of Rapid HIV Testing in Substance Use Disorder Treatment Programs
2016. Journal of Substance Abuse Treatment 63: 46–53

Frimpong, J.A., D'Aunno, T., Helleringer, S., & Metsch, L.
05/25/2016

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.

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.

Child diarrhea and nutritional status in rural Rwanda: a cross-sectional study to explore contributing environmental and demographic factors

Child diarrhea and nutritional status in rural Rwanda: a cross-sectional study to explore contributing environmental and demographic factors
DOI: 10.1111/tmi.12725

Sheela S. Sinharoy, Wolf-Peter Schmidt, Kris Cox, Zachary Clemence, Leodomir Mfura, Ronald Wendt, Sophie Boisson, Erin Crossett, Karen A. Grépin, William Jack, Jeannine Condo, James Habyarimana and Thomas Clasen
05/23/2016

Objective

To explore associations of environmental and demographic factors with diarrhoea and nutritional status among children in Rusizi district, Rwanda.

Methods

We obtained cross-sectional data from 8,847 households in May–August 2013 from a baseline survey conducted for an evaluation of an integrated health intervention. We collected data on diarrhoea, water quality, and environmental and demographic factors from households with children <5, and anthropometry from children <2. We conducted log-binomial regression using diarrhoea, stunting and wasting as dependent variables.

Results

Among children <5, 8.7% reported diarrhoea in the previous 7 days. Among children <2, stunting prevalence was 34.9% and wasting prevalence was 2.1%. Drinking water treatment (any method) was inversely associated with caregiver-reported diarrhoea in the previous seven days (PR=0.79, 95% CI: 0.68-0.91). Improved source of drinking water (PR=0.80, 95% CI:0.73-0.87), appropriate treatment of drinking water (PR=0.88, 95% CI:0.80-0.96), improved sanitation facility (PR=0.90, 95% CI:0.82-0.97), and complete structure (having walls, floor, and roof) of the sanitation facility (PR=0.65, 95% CI:0.50-0.84) were inversely associated with stunting. None of the exposure variables were associated with wasting. A microbiological indicator of water quality was not associated with diarrhoea or stunting.

Conclusions

Our findings suggest that in Rusizi district, appropriate treatment of drinking water may be an important factor in diarrhoea in children <5, while improved source and appropriate treatment of drinking water as well as improved type and structure of sanitation facility may be important for linear growth in children <2. We did not detect an association with water quality.

Needed: Global Collaboration for Comparative Research on Cities and Health

Needed: Global Collaboration for Comparative Research on Cities and Health
International Journal of Health Policy and Management

Rodwin, VG. and Gusmano, MK.
05/02/2016

Over half of the world’s population lives in cities and United Nations (UN) demographers project an increase of 2.5 billion more urban dwellers by 2050. Yet there is too little systematic comparative research on the practice of urban health policy and management (HPAM), particularly in the megacities of middle-income and developing nations. We make a case for creating a global database on cities, population health and healthcare systems. The expenses involved in data collection would be difficult to justify without some review of previous work, some agreement on indicators worth measuring, conceptual and methodological considerations to guide the construction of the global database, and a set of research questions and hypotheses to test. We, therefore, address these issues in a manner that we hope will stimulate further discussion and collaboration.

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