Center for Health Enhancement Systems Studies, Industrial and Systems Engineering Department, College of Engineering, University of Wisconsin–Madison, 1513 University Avenue, Madison, WI 53706, USA.
Addiction. 2013 Jun;108(6):1145-57. doi: 10.1111/add.12117. Epub 2013 Mar 1.
Improvement collaboratives consisting of various components are used throughout health care to improve quality, but no study has identified which components work best. This study tested the effectiveness of different components in addiction treatment services, hypothesizing that a combination of all components would be most effective.
An unblinded cluster-randomized trial assigned clinics to one of four groups: interest circle calls (group teleconferences), clinic-level coaching, learning sessions (large face-to-face meetings) and a combination of all three. Interest circle calls functioned as a minimal intervention comparison group.
Out-patient addiction treatment clinics in the United States.
Two hundred and one clinics in five states.
Clinic data managers submitted data on three primary outcomes: waiting-time (mean days between first contact and first treatment), retention (percentage of patients retained from first to fourth treatment session) and annual number of new patients. State and group costs were collected for a cost-effectiveness analysis.
Waiting-time declined significantly for three groups: coaching (an average of 4.6 days/clinic, P = 0.001), learning sessions (3.5 days/clinic, P = 0.012) and the combination (4.7 days/clinic, P = 0.001). The coaching and combination groups increased significantly the number of new patients (19.5%, P = 0.028; 8.9%, P = 0.029; respectively). Interest circle calls showed no significant effect on outcomes. None of the groups improved retention significantly. The estimated cost per clinic was $2878 for coaching versus $7930 for the combination. Coaching and the combination of collaborative components were about equally effective in achieving study aims, but coaching was substantially more cost-effective.
When trying to improve the effectiveness of addiction treatment services, clinic-level coaching appears to help improve waiting-time and number of new patients while other components of improvement collaboratives (interest circles calls and learning sessions) do not seem to add further value.
改良协作由各种组成部分组成，广泛应用于医疗保健领域以提高质量，但尚无研究确定哪些组成部分效果最佳。本研究测试了不同组成部分在成瘾治疗服务中的有效性，假设所有组成部分的结合将是最有效的。
一项非盲聚类随机试验将诊所分配到以下四个组之一：兴趣圈电话（小组电话会议）、诊所级教练、学习会议（大型面对面会议）以及所有这三个的组合。兴趣圈电话作为一项最小干预的比较组。
美国的门诊成瘾治疗诊所。
五个州的 201 个诊所。
诊所数据管理员提交了三个主要结果的数据：等待时间（从第一次接触到第一次治疗之间的平均天数）、保留率（从第一次到第四次治疗的保留率）和新患者的年度数量。为成本效益分析收集了州和组的成本。
三组的等待时间显著下降：教练（平均每个诊所 4.6 天，P=0.001）、学习会议（每个诊所 3.5 天，P=0.012）和组合（每个诊所 4.7 天，P=0.001）。教练和组合组显著增加了新患者的数量（分别为 19.5%，P=0.028；8.9%，P=0.029）。兴趣圈电话对结果没有显著影响。没有一个组显著提高保留率。每个诊所的估计成本为教练组 2878 美元，组合组 7930 美元。在实现研究目标方面，教练和协作组件的组合在效果上大致相当，但教练的成本效益更高。
在试图提高成瘾治疗服务的效果时，诊所级教练似乎有助于缩短等待时间和增加新患者的数量，而改良协作的其他组成部分（兴趣圈电话和学习会议）似乎没有增加更多价值。
