E-health Implementation (Iowa)
Study Details
Study Description
Brief Summary
This research will test a technology adoption framework to increase use of the A-CHESS smartphone app. The project, based in Iowa, will compare a control condition (using a typical product training approach to software implementation that includes user tutorials and instruction on administrative and clinical protocols, followed by access to on-line support) to the typical product training combined with NIATx-TI.
Terms - A-CHESS: Addiction Comprehensive Health Enhancement Support System NIATx-TI: Network for the Improvement of Addiction Treatment-Technology Implementation
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Detailed Description
Patient-centered e-health has failed to achieve its promise despite considerable consumer interest in technology and research supporting its potential. E-health adoption rates in healthcare are poor, with specialty substance use disorder (SUD) treatment having the lowest technology adoption rate of any sector. Implementation science can address this emerging gap in the e-health field by augmenting existing models, that explain organizational and individual e-health behaviors retrospectively, with prospective models that can guide implementation. The organizational planning discipline, with its decades of research, could provide a cross-disciplinary "jump start" to developing an e-health implementation model for health organizations. Henry Mintzberg, a respected pioneer in this field, describes 2 beneficial approaches to planning: the deliberate approach, which is grounded in pre-implementation planning, and the emergent approach that is grounded in adapting to the environment as the plan is implemented. The proposed e-health implementation model, called the Network for the Improvement of Addiction Treatment-Technology Implementation (NIATx-TI) Framework, incorporates both approaches.
NIATx-TI was piloted in the Iowa Rural Health Information Technology Initiative (IRHIT) with 14 of Iowa's 105 SUD treatment sites and resulted in a 2-fold increase in patients receiving distance treatment. The framework's deliberate component includes using an organizational technology assessment and patient simulation. These tools identify and address assets and barriers to incorporate into the technology's implementation protocol. The framework's emergent component includes using a project team to uncover and prioritize implementation barriers as they arise, develop changes to address identified barriers, and monitor selected adoption measures, while receiving monthly coaching.
This project, based in Iowa, will compare a control condition (using a typical product training approach to software implementation that includes user tutorials and instruction on administrative and clinical protocols, followed by access to on-line support) to the typical product training combined with NIATx-TI. While e-health spans many modalities and health disciplines, this project will focus on the implementing Addiction Comprehensive Health Enhancement Support System (A-CHESS), an evidence-based SUD treatment recovery app developed by our Center for a disease that affects 21.5 million and kills 136,000 Americans annually: substance use disorder. A mobile app was selected, as opposed to another e-health technology, because of the near ubiquitous daily use of mobile technology and because mobile e-health adoption requires supportive participation of both health centers and patients.
In response to the COVID-19 pandemic, the study team added a study component focused on describing how patients are responding to receiving remote treatment (e.g., telehealth). The study team will also seek to understand how using A-CHESS mitigates COVID-19 associated anxiety and loneliness among those with substance use disorders.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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No Intervention: TAU/Control Sites in the Treatment as Usual (TAU)/Control Arm will receive product training/online support. Sites in the TAU/Control Arm will participate in a one-day product implementation or training session. |
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Experimental: NIATx-TI Framework Sites in the NIATx-TI Arm will receive product training/online support, and training in the NIATx-TI framework. The NIATx-TI framework will include a pre-implementation (planning) phase, and post-implementation (problem-solving) phase, with training delivered by a NIATx-TI coach. |
Behavioral: NIATx-TI with Product Training/On-line Support
NIATx-TI framework includes the product training as well as a preimplementation phase and a post-implementation phase. A NIATx-TI coach will provide the training for this arm. The coach will also assist the organizations with applying the NIATx-TI framework.
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Outcome Measures
Primary Outcome Measures
- Reach: As assessed by the percentage of participants that download the A-CHESS app [Monthly, up to 52 months]
The percentage of participants that download the A-CHESS app will be obtained monthly during the study via the A-CHESS server and Iowa Department of Public Health (IDPH) data.
- Reach: As assessed by the number of days that participants use the A-CHESS [Monthly, up to 52 months]
The frequency of use of A-CHESS by each participant will be obtained monthly during the study via the A-CHESS server and Iowa Department of Public Health (IDPH) data.
Secondary Outcome Measures
- Effectiveness of A-CHESS as assessed by the retention rate of eligible participants. [Collected monthly during months 13 - 52]
Retention rates of eligible participants
- Adoption: Number of days each counselor used the A-CHESS [Monthly, up to 52 months]
Number of days each counselor used the A-CHESS will be assessed by A-CHESS logs
- Adoption - The percentage of counselors using A-CHESS will be assessed via the organizational survey and A-CHESS logs [Collected twice during study; starting M22 - 31 and M35-44]
Organizational survey will be completed by a member of the management team two times during the project (organizational baseline, end of the intervention)
- A-CHESS/NIATx Implementation Fidelity (Survey) [Collected twice during study; approx. M14 - 25 and M32 - 43]
Survey data on participating organizations' fidelity to the NIATx Technology Implementation (NIATx-TI) process.
- Organizational readiness of participating organizations as assessed by Organizational Change Manager (Survey) [Collected twice during study; approx. M14 - 25 and M32 - 43]
Survey data on the organizational readiness of participating organizations.
- Financial Resource Availability (Survey) [Collected twice during study; starting M22 - 31 and M35-44]
Survey data on how the organization's financial resource availability affects A-CHESS implementation.
- Difference in number of admissions in rural vs. urban location [Collected during months 7, 18, 30, and 42]
Statistical analysis of organizational traits will be done by calculating the difference in number of admissions in rural vs. urban location
Other Outcome Measures
- Supplement 1 - Understand impact of ACHESS on pt anxiety and loneliness during COVID-19 pandemic [M34-37]
Online survey
- Supplement 2 - Understand how treatment organizations and staff used ACHESS during COVID pandemic [M34-37]
Online survey
Eligibility Criteria
Criteria
Inclusion Criteria:
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Must be 18+ years old
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Understand English
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Have a SUD diagnosis
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Have access to a smartphone
Exclusion Criteria:
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Zion Recovery Services | Adel | Iowa | United States | 50003 |
2 | Prairie Ridge Integrated Behavioral Healthcare | Algona | Iowa | United States | 50511 |
3 | Community and Family Resources | Ames | Iowa | United States | 50010 |
4 | Area Substance Abuse Council | Anamosa | Iowa | United States | 53305 |
5 | UCS Healthcare | Ankeny | Iowa | United States | 50021 |
6 | Zion Recovery Services | Atlantic | Iowa | United States | 50022 |
7 | Area Substance Abuse Council | Belle Plaine | Iowa | United States | 52208 |
8 | Community and Family Resources | Boone | Iowa | United States | 50036 |
9 | Alcohol and Drug Dependency Services (ADDS) | Burlington | Iowa | United States | 52601 |
10 | Area Substance Abuse Council | Cedar Rapids | Iowa | United States | 52404 |
11 | Prairie Ridge Integrated Behavioral Healthcare | Charles City | Iowa | United States | 50616 |
12 | Jackson Recovery Centers | Cherokee | Iowa | United States | 51012 |
13 | Prelude Behavioral Health Services | Clarence | Iowa | United States | 52216 |
14 | Zion Recovery Services | Clarinda | Iowa | United States | 51632 |
15 | Community and Family Resources | Clarion | Iowa | United States | 50525 |
16 | Heartland Family Services | Council Bluffs | Iowa | United States | 51503 |
17 | Area Substance Abuse Council | De Witt | Iowa | United States | 52742 |
18 | Jackson Recovery Centers | Denison | Iowa | United States | 51442 |
19 | UCS Healthcare | Des Moines | Iowa | United States | 50310 |
20 | House of Mercy | Des Moines | Iowa | United States | 50314 |
21 | Prelude Behavioral Health Services | Des Moines | Iowa | United States | 50317 |
22 | Substance Abuse Services Center | Dubuque | Iowa | United States | 52001 |
23 | Prairie Ridge Integrated Behavioral Healthcare | Forest City | Iowa | United States | 50436 |
24 | Community and Family Resources | Fort Dodge | Iowa | United States | 50501 |
25 | Heartland Family Services | Glenwood | Iowa | United States | 51534 |
26 | Zion Recovery Services | Greenfield | Iowa | United States | 50849 |
27 | Prairie Ridge Integrated Behavioral Healthcare | Hampton | Iowa | United States | 50441 |
28 | Community and Family Resources | Humboldt | Iowa | United States | 50548 |
29 | House of Mercy | Indianola | Iowa | United States | 50125 |
30 | Prelude Behavioral Services | Iowa City | Iowa | United States | 52240 |
31 | ADDS | Keokuk | Iowa | United States | 52362 |
32 | UCS Healthcare | Knoxville | Iowa | United States | 50138 |
33 | Jackson Recovery Centers | Le Mars | Iowa | United States | 51031 |
34 | Heartland Family Services | Logan | Iowa | United States | 51546 |
35 | Area Substance Abuse Council | Maquoketa | Iowa | United States | 52060 |
36 | Prelude Behavioral Health Services | Marengo | Iowa | United States | 52301 |
37 | Prairie Ridge Integrated Behavioral Healthcare | Mason City | Iowa | United States | 50401 |
38 | ADDS | Mount Pleasant | Iowa | United States | 52641 |
39 | House of Mercy | Newton | Iowa | United States | 50208 |
40 | Zion Recovery Services | Perry | Iowa | United States | 50220 |
41 | Community and Family Resources | Pocahontas | Iowa | United States | 50574 |
42 | Zion Recovery Services | Red Oak | Iowa | United States | 51566 |
43 | Community and Family Resources | Rockwell City | Iowa | United States | 50579 |
44 | Zion Recovery Services | Shenandoah | Iowa | United States | 51601 |
45 | Jackson Recovery Centers | Sioux City | Iowa | United States | 51101 |
46 | Prelude Behavioral Services | Tipton | Iowa | United States | 52772 |
47 | Area Substance ABuse Council | Vinton | Iowa | United States | 52349 |
48 | ADDS | Wapello | Iowa | United States | 52632 |
49 | Community and Family Resources | Webster City | Iowa | United States | 50595 |
Sponsors and Collaborators
- University of Wisconsin, Madison
- University of Iowa
- Iowa Department of Public Health
- National Institute on Drug Abuse (NIDA)
Investigators
- Principal Investigator: Todd Molfenter, Ph.D., University of Wisconisn-Madison
- Principal Investigator: David Gustafson, Ph.D., University of Wisconsin, Madison
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 2018-0997
- A195010
- ENGR/INDUSTRIAL ENGR
- 1R01DA044159-01A1
- 3R01DA044159-02S1
- Protocol version: 02-15-2021
- 2020-0833