Standardized outcomes tracking on the rise

The field of addiction treatment has traditionally relied on the experience of a clinician during treatment, but a new emphasis on outcomes measures by both insurers and accrediting bodies is placing an increased focused on measurable, quantitative outcomes for patients while they are in treatment and during follow-up. “We are starting to get contracts with insurance companies that are requiring the use of standardized measures, so it’s starting,” said Nick Hayes, MS, LMFTA, LCDC, director of clinical research and outcomes for the Cumberland Heights Foundation. As of Jan. 1 of this year, the Joint Commission also now requires behavioral healthcare centers seeking accreditation to conduct outcomes assessments through the “use of a standardized tool or instrument.” Hayes says treatment centers that don’t hire appropriate staff or devote the necessary resources today to incorporate effective measurement practices will be “left behind” as the field continues to push toward more effective and standardized methods of outcomes tracking. Current landscape The practice of outcomes tracking today varies significantly across treatment facilities. According to Jessica Swan, MCJ, NCACII, CACII, outcomes manager for the National Association of Addiction Treatment Providers (NAATP), there are some providers who are doing excellent research and data collection, some centers that aren’t doing it at all and other “opportunistic” centers that are relying on misinformation or marketing research rather an actual scientific research. “There’s a wide variety because there’s been a huge amount of growth in the field,” she says. Joanna Conti, president and chief executive officer of Vista Research Group, discovered the lack of outcomes data among addiction treatment facilities firsthand while she was trying to find help for her daughter who struggled with an alcohol addiction and needed urgent placement in a treatment center. “Each time I was forced to make what was a real life-and-death decision for my family on the basis of a phone call with somebody who sounded nice and said, ‘Trust me we are better than the rest,’ ” Conti says. After her daughter found sobriety, Conti created the website Conquer Addiction to help families find a treatment facility, emphasizing those that tracked outcomes measures by using solid, scientific data and shared those figures. But, there were only five centers across the country in 2015 that she felt met those requirements, she says. Efforts to improve outcomes tracking Seeing the lack of outcomes tracking in the field, Conti put the website on the backburner and opened Vista Research Group, a company designed to help facilities track outcome measures such as depression, anxiety, trauma, eating disorders, suicidal thoughts, satisfaction with treatment and how well the patient is getting along with family. The organization also helps facilities monitor for mania, psychosis, functioning and medication adherence. “When the Joint Commission came out with their requirement this January that said you need to be tracking your outcomes, we had already been doing it for almost two years,” she says. “We can provide real-time outcomes measures. You know everything we do is patient reported online. The clinicians can log in and instantly see how their patients are doing.” NAATP has also set out to improve outcomes tracking and revamped the organization’s ethics code to require that members do outcomes research and follow marketing guidelines and ethics in reporting outcomes. The association also is concluding a three-year research project called the Outcomes Pilot Program to study the most effective ways to track outcomes and plan to create a toolkit for members that is expected to be out by the end of the year. “The goal of this whole process was to really help standardize the process of data collection for outcomes and help treatment programs implement the process of data collection in their own centers so that they could all track their own outcomes in a recommended, standardized kind of way,” Swan says. What is a good outcome? There are some facilities that make claims such as having an 80% success rate, without divulging what they consider “success” or what data they have behind making the claims. Hayes called this practice negligent and says facilities need to base any claims they make on scientific data. Many times, these figures are also referring to treatment completion rates, rather than indicating anything about a patient’s change in symptoms or improvement. “Program completion doesn’t equal success or life change. Completing a program is not indicative of long-term change for a chronic disease,” Swan says. Both Hayes and Swan also say solely relying on “abstinence” as an outcome measure may not truly reflect all the areas of progress a patient has made or accurately reflect their current condition. “ ‘A successful person is a person who isn’t using any more,’ that’s a pretty black-and-white statement, and there is a lot more to living in recovery than staying off drugs and alcohol,” Swan says. Hayes advocates for clinical outcome monitoring programs that evaluate patients throughout treatment and assess self-reported aspects such as levels of depression, anxiety or impulsivity, to assess their longitudinal growth or identify areas of focus during treatment. “There’s always other measurements or barometers of change that we could be capturing that could help us effectively model how our clients are changing through time,” he says. Swan says it’s also important for facilities to monitor outcomes after a patient leaves treatment to help identify areas a program does well, and areas where there may be room for improvement. In the NAATP pilot study, outcomes were assessed at baseline, one month, 90 days, six months, nine months and one year. Swan also recommends assessing multiple factors at baseline, such as where people are at with their social life, family life, with their interpersonal relationships, mental health, emotional health and abstinence or use of alcohol and drugs, and monitor those same factors over time. “We’re trying to get the language redefined so that we understand that outcomes of people isn’t a matter of success or failure so much as maybe remission and relapse and improvement of life over time,” she says. Challenges to outcomes tracking Experts agree that more and more entities are requiring effective and standardized means of outcomes tracking in substance abuse treatment, but doing it effectively can still be a challenge. Effective outcomes tracking takes a considerable amount of time. For instance, Conti says her firm typically must reach out to a person between 10 and 15 times before they are able to capture one data point and they even pay respondents a small amount for their time. “I think the biggest challenge that treatment centers have is it’s really difficult to do, I mean we have systematized it,” she says. Swan says centers need to devote sufficient resources to accomplish the task and can’t simply have an admissions coordinator or clinician try to pick up the responsibility along with their other duties. It can also be overwhelming for centers, especially smaller centers, to begin implementing tracking methods, but Swan hopes the toolkit will help provide step-by-step directions to implementing programs. Despite the challenges, experts agree that it’s a step treatment centers need to take. “If you are going to be in this field and doing this work, you need to be doing this as part of it,” Swan says. Jill Sederstrom is a freelance writer based in Kansas City.