Exploring Substance Abuse Treatment Centers

1
Improving Quality by Aligning Physicians

• Exploring Substance Abuse Treatment Centers

Sayeda Haq
2
Substance Abuse Care Alignment

• Alignment is crucial in SA care as
• Most physicians work for specialized treatment
  centers, often for multiple organizations
• Treatment modalities vary sharply
• Diverse treatment philosophy and orientation
  among all providers
• Large number of non-physician providers

Thomas 2007
3
Quality Chasm in Substance Abuse Care

• People with a substance use disorder
  22 million
• People receiving care
  3.5 million

2001 (aged 12 or older)
SAMHSA, DHHS Pub SMA 05-3999, 2005

• Effective treatments exist and continually
  improve. However, as with general health care,
  deficiencies in care delivery prevent many from
  receiving appropriate treatments.

IOM Quality Chasm Series, 2006
4
New Medication - Buprenorphine

• Offers several clinical advantages over Methadone
• Can be prescribed in physicians office
• Does not have severe withdrawal symptoms
• Daily dosing not needed due to long-acting
  effects
• No detectable high
• 2000 Federal Legislation allows MDs to prescribe
  in office visits
• 2002 FDA approves outpatient prescription
• However
• Four years after legislation, not incorporated
  into common treatment of substance abuse

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An Alignment Problem?
Org
Org does not
Recommends
recommend
MD does not
MD does not
MD Prescribes
MD Prescribes
Prescribe
Prescribe
74
44
56
26
In multivariate result, organizational support
remained important in MDs adoption decision,
after controlling for MD demographics, case mix,
practice characteristics etc.
Thomas 2007
6
What Determines Alignment?

• Financial incentives - most studied domain
• Administrative strategies, e.g. utilization
  review, referral requirements
• Significant number of studies
• Structural characteristics of organization, e.g.
  location of practice site, availability of
  services, supporting staff and governance style
• Some studies
• Normative influence, e.g. formal and informal
  interaction and feedback from professional
  colleagues, organizational culture
• Very few studies
• Difficult to measure

Landon et al (1998)
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Conceptual Framework
Adler and Borys, 1996
8
Research Question Hypotheses
What specific structural or normative strategies
used by organizations are effective in aligning
physicians?

• Physicians alignment (loyalty, commitment)
  increases when
• Organizations offer value-added services, such as
  training, supporting staff, etc.
• Governance-style is consensus-based and
  participatory
• Leadership shares information leading to
  goal-congruence
• Free flow of information, frank discussion of
  failures, collegial relationship exists among
  employees

9
Analytical Model
Organizations
Strategies (independent variables)
Alignment (dependent variable)

• Structural
• Value-added
• Operational
• Normative/
• Informative
• Formal
• Informal

When Organization adopts and affiliated MDs
prescribe
Treatment Organization
10
Sample Study Population

• Part of a larger study by Schneider Institute
• MD Survey Addiction specialists and facility
  directors
• N 271 (69 response rate)
• Organization survey Facility directors
• N 125 (51 response rate)
• Analysis on merged dataset
• N 72 MDs, representing 46 organizations
• Unit of analysis is respondents (N 72)
• Aligned 24 (33) Not-aligned 48 (67)
• 6-point scale independent variables
• 1 through 4 gt not much
• 5,6 gt very much

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Preliminary (Bivariate) findings
p-value lt 0.1, p-value lt 0.05, p-value
lt 0.01
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Research Implications

• Health services research is consistent with
  broader organizational theory of governance
• Organizations indeed affect physicians
  practice-behavior
• This study explicitly measures, specifies and
  evaluates strategies that organizations can adopt
  to align autonomous professionals
• Policy Implication
• Findings help bridge the gap between knowledge
  and practice both in SA treatment and in general
  health care system