E-health Implementation (Iowa)

Not Applicable

Completed

Conditions: Substance Use Disorders

Interventions: Behavioral: NIATx-TI with Product Training/On-line Support

Registration Number: NCT03954184

Lead Sponsor: University of Wisconsin, Madison

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

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.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 23659

Inclusion Criteria

Must be 18+ years old
Understand English
Have a SUD diagnosis
Have access to a smartphone

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
NIATx-TI Framework	NIATx-TI with Product Training/On-line Support	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.

Primary Outcome Measures

Name	Time	Method
Reach: As Assessed by the Mean Number of Clinics With Participants Who Download the A-CHESS App	45 months	The mean number of clinics with patients who 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	45 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

Name	Time	Method
Effectiveness of A-CHESS as Assessed by the Retention Rate of Eligible Participants.	Collected monthly during months 13 - 45	Retention rates of eligible participants
Adoption: Number of Days Each Counselor Used the A-CHESS	45 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. The Implementation Fidelity survey is a 13 item questionnaire using a 4-point scale where 0 = Not True and 4 = True. Scores range from 0-52. Higher scores indicate greater implementation fidelity.
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. Organizational Readiness (as measured by Organizational Change Manager) - 5 categories from Not True (0) to True (3) and Don't Know (No score). Scores range from 0-66. Higher scores indicate greater readiness for change.
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. Scored the availability of financial resources on a 5-point scale from 0= Not Ture to 4= True. Scores range from 0-28. Higher score indicates greater availability of resources.
Difference in Number of Admissions in Rural vs. Urban Location	Collected during months 7, 18, 30, and 42, month 42 reported	Statistical analysis of organizational traits will be done by calculating the difference in number of admissions in rural vs. urban location. The number of clinics located in a rural area was counted. The number of clinics in an urban location were counted.

Trial Locations

Locations (14): Alcohol and Drug Dependency Services (ADDS)
🇺🇸
Burlington, Iowa, United States
Substance Abuse Services Center
🇺🇸
Dubuque, Iowa, United States
Area Substance Abuse Council
🇺🇸
Maquoketa, Iowa, United States
Area Substance ABuse Council
🇺🇸
Vinton, Iowa, United States
Jackson Recovery Centers
🇺🇸
Sioux City, Iowa, United States
House of Mercy
🇺🇸
Newton, Iowa, United States
Prelude Behavioral Services
🇺🇸
Tipton, Iowa, United States
Prelude Behavioral Health Services
🇺🇸
Marengo, Iowa, United States
ADDS
🇺🇸
Wapello, Iowa, United States
Zion Recovery Services
🇺🇸
Shenandoah, Iowa, United States
Prairie Ridge Integrated Behavioral Healthcare
🇺🇸
Mason City, Iowa, United States
Community and Family Resources
🇺🇸
Webster City, Iowa, United States
UCS Healthcare
🇺🇸
Knoxville, Iowa, United States
Heartland Family Services
🇺🇸
Logan, Iowa, United States