Testing of a patient-centered e-health implementation model in addiction treatment
We will test the effectiveness of the Network for the Improvement of Addiction Treatment-Technology Implementation framework in implementing the A-CHESS substance use disorder treatment and recovery app at 16 treatment organizations in Iowa.
Mobile phone apps such as ACHESS offer continual addiction recovery support, expanding the availability of effective addiction care. Yet, the low rates of use of A-CHESS and other patient-centered e-health addiction treatment technologies underscore the need for effective, systematic approaches to adopting technology that supports patient recovery outside the clinic walls. The proposed research will test the ability of the NIATx-Technology Implementation (NIATx-TI) Framework and traditional technology product training to reduce the gap between e-health research evidence and practice and help treatment organizations and consumers benefit from the emerging technological advances in addiction treatment and recovery.
The gap between the need for and the effectiveness of substance use disorder treatment services calls for implementing fundamentally different treatment modalities to improve substance use disorder. Patient-centered mobile e-health technologies offer innovative ways to improve treatment and recovery supports for substance use disorders. Despite the promise of e-health, its potential benefits are far from being realized. A prominent example of this is in substance use disorder care. Despite the availability of evidence-based e-health tools such as the Drinkerâ€™s Check-up, Therapeutic Education System (TES), CBT, CBT, and A-CHESS, none of these technologies are used by > 1% of substance use treatment providers. This proposal tests the premise that an evidence-based technology implementation framework can reduce the gap between patient-centered e-health evidence and practice.
The proposed mixed methods study uses the RE-AIM framework to compare NIATx-TI with Product training/ On-line Support (Arm 2) to Product Training/On-line Support alone (Arm 1) in implementing the ACHESS mobile app. Sixteen SUD organizations in Iowa will be assigned to the 2 study conditions, n=8 organizations per arm. The treatment period will be an 18-month test period and an 18- month post-test or maintenance period. Each participating organization will contribute 1 to 5 outpatient sites to the trial, with a total of 40 of Iowaâ€™s outpatient sites participating in the study. Randomization occurs at the organizational level, with outcomes collected at the site level since each site represents a unique location and organizational structure. Sites are clustered by organization, resulting in 8 organizations and 20 sites per arm.
Specific Aims: Compare the impact of NIATx-TI (Arm 2/Treatment) and Product Training/On-Line Training (Arm1/Control) in implementing an-evidence based innovation (ACHESS). Impact will be measured using these RE-AIM elements and assessed through the mediational analysis described below:
- Reach or Participation (Primary Outcome): a) percent and representativeness, based on age, gender, and ethnicity of eligible patients who download ACHESS, and b) ACHESS use, by days of use
- Effectiveness: illicit substance and alcohol abstinence and days of use, as well as retention rates of eligible patients who use and do not use ACHESS
- Adoption: a) percent and representativeness based on gender, age, and education level of counselors using ACHESS, b) clinician and c) patient acceptance using the Technology Acceptance Model (TAM),9 and d) a qualitative analysis of patient readiness for ACHESS
- Implementation: a) organizational readiness for, and b) fidelity of ACHESS implementation, and c) qualitative and d) cost effectiveness analyses to develop a better understanding of the implementation processes for delivering NIATx-TI compared to product training/on-line support alone
- Maintenance: ACHESS use (e.g., ACHESS downloads and days of use) during the post-test phase.
- Funding Period:
- September 1, 2018 - June 30, 2023
- Principal Investigators:
- David Gustafson Sr., Ph.D
- Todd Molfentor, Ph.D
- Jee-Seon Kim, Ph.D.