“Research tells us that patients that follow through with aftercare have the best chance for a lasting recovery,” said Dr. Patrice Muchowski, vice president of clinical services. “Continuation in treatment is even more critical now that inpatient lengths of stay are brief and some patients only participate in detoxification services.” “At the same time, national and state data suggest that patient continuation is poor,” said Jack Maroney, MS, LADC-I, community services representative. “Moreover, observations within AdCare’s continuum of care lead us to believe we could do better.”
A Systematic, Team Approach to Change
AdCare Hospital adopted a systematic, team approach toward promoting outpatient treatment. The “Bridging the Gap” improvement project evolved from the five key principles espoused by the Network for the Improvement of Addiction Treatment (NIATx): define the problem; generate and implement solutions; evaluate solutions; and repeat the four steps until the problem is solved.
Convening a multi-disciplinary change team was the first step. AdCare’s team was comprised of change leader Patrice Muchowski, Sc.D., vice president of clinical services; Jack Maroney, MS, LADC-I, community services representative; Joanne Bryant, BSN, RN, nurse manager; Christine Caola, MA, rehabilitation counselor; Jane Jolly, director of outpatient operations; Jeremy Potter, MSW, LICSW, outpatient clinical supervisor; and Felix Rodriguez, CADAC, detoxification counselor.
The Evolution of the Plan – the Pilot
Team members suggested possible reasons why some patients follow through with treatment while other patients do not pursue treatment upon discharge. Patients identified several obstacles to continuing in treatment. Colleagues suggested that new strategies were needed to improve continuum of care outcomes. Recommendations included: the importance of talking about the continuum of care at every possible opportunity during a patient’s inpatient stay; conducting a Day of Discharge Motivational Group; distributing patient surveys; and analyzing survey responses to measure outcomes.
Day of Discharge Motivational Group
Formed in response to patient and staff feedback, a Day of Discharge Group was piloted on a detoxification unit of AdCare Hospital. The Day of Discharge Group featured an audio/visual motivational presentation and patient discussion around aftercare. The results did not meet expectations. Less than 50% of patients being discharged were exposed to the group. Patient survey responses showed no statistically significant improvement in understanding of the value of outpatient treatment and no statistically significant improvement in motivation to pursue treatment.
Third-Day-of-Stay Group
The poor outcomes of the Day of Discharge Group prompted a re-evaluation of the pilot. Solutions were suggested and implemented. The Day of Discharge Group evolved into a Third Day of Stay Group. This group continued to focus on the value of aftercare, identifying and discussing barriers to treatment such as transportation, child care, waiting time, and fear of the unknown.
The results were remarkable. Survey responses indicated a statistically significant improvement in patient understanding of the benefits of outpatient care and an increase in patient confidence/motivation to pursue treatment. An analysis of discharge plans revealed a 72 percent increase in aftercare plan acceptance over treatment as usual and a 37 percent increase in patient continuation in treatment (raw percentage). The percentage increase in patients utilizing outpatient services was even higher for patients continuing in the AdCare system.
From Pilot to Practice
The highly successful Third-Day-of-Stay pilot was extended to detoxification patients on all units of the hospital. This post-pilot project required additional coordination, cooperation, and training of staff, and monitoring of results.
“The marked increase in patient utilization of our outpatient services resulting from both the pilot and the extended project was well worth the effort,” said Dr. Muchowski. “At AdCare, we understand that patient continuation in treatment is the key to recovery; we consistently seek ways to bolster patient motivation to remain in treatment long enough to succeed.”
