Implementation of Smartphone Systems to Improve Quality of Life for People With Substance Use Disorder: Interim Report on a Randomized Controlled Trial

David Gustafson Sr, Julie Horst, Deanne Boss, Kathryn Fleddermann, Nora Jacobson, Mathew Roosa, J Charles Ross, Rachel Gicquelais, Olivia Vjorn, Tracy Siegler, Todd Molfenter, David Gustafson Sr, Julie Horst, Deanne Boss, Kathryn Fleddermann, Nora Jacobson, Mathew Roosa, J Charles Ross, Rachel Gicquelais, Olivia Vjorn, Tracy Siegler, Todd Molfenter

Abstract

Background: Researchers have conducted numerous studies seeking to understand how to improve the implementation of changes in health care organizations, but less focus has been given to applying lessons already learned from implementation science. Finding innovative ways to apply these findings efficiently and consistently will improve current research on implementation strategies and allow organizations utilizing these techniques to make changes more effectively.

Objective: This research aims to compare a practical implementation approach that uses principles from prior implementation studies to more traditional ways of implementing change.

Methods: A total of 43 addiction treatment sites in Iowa were randomly assigned to 2 different implementation strategies in a randomized comparative effectiveness trial studying the implementation of an eHealth substance use disorder treatment technology. One strategy used an adaptation of the Network for the Improvement of Addiction Treatment (NIATx) improvement approach, while the other used a traditional product training model. This paper discusses lessons learned about implementation.

Results: This midterm report indicates that use of the NIATx approach appears to be leading to improved outcomes on several measures, including initial and sustained use of new technology by both counselors and patients. Additionally, this research indicates that seamlessly integrating organizational changes into existing workflows and using coaching to overcome hurdles and assess progress are important to improve implementation projects.

Conclusions: At this interim point in the study, it appears that the use of the NIATx improvement process leads to better outcomes in implementation of changes within health care organizations. Moreover, some strategies used in this improvement process are particularly useful and should be drawn on more heavily in future implementation efforts.

Trial registration: ClinicalTrials.gov NCT03954184; https://ichgcp.net/clinical-trials-registry/NCT03954184.

Keywords: NIATx; coaching; mobile technology; substance use disorder (SUD) treatment; technology implementation model.

Conflict of interest statement

Conflicts of Interest: DG is a part-owner of CHESS Health, which is devoted to marketing information technologies to agencies that deliver addiction treatment. He is also on the board of directors of the nonprofit NIATx Foundation, as well as a small consulting company. These relationships do not carry any restrictions on publication, and any associated intellectual property will be disclosed and processed according to his institution’s policies. TM is a faculty member at CHESS and has a less than .1% ownership with CHESS Health, the organization responsible for making the ACHESS addiction recovery app commercially available to the public. TM has worked extensively with his institution to manage any conflicts of interest. An external advisory board approved all survey instruments applied, and the individuals who will conduct the data collection and interpretation for this study will have no affiliation with CHESS Health. Additionally, parts of the NIATx organizational change model used in part of this trial were developed by the Center for Health Enhancement System Studies (CHESS) at the University of Wisconsin-Madison, where TM is a faculty member. He is also affiliated with the NIATx Foundation, the organization responsible for making the NIATx organizational change model available to the public. For this scenario, DG and TM have an institutionally approved plan to manage potential conflicts of interest. The individuals who will conduct the data collection and interpretation for this study manuscript will have no affiliation with the NIATx Foundation or CHESS Health.

©David Gustafson Sr, Julie Horst, Deanne Boss, Kathryn Fleddermann, Nora Jacobson, Mathew Roosa, J Charles Ross, Rachel Gicquelais, Olivia Vjorn, Tracy Siegler, Todd Molfenter. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 14.07.2022.

Figures

Figure 1
Figure 1
RISE Iowa (Recovering Iowans Supporting Each Other) app.
Figure 2
Figure 2
Counselors' average days of use of RISE Iowa (Recovering Iowans Supporting Each Other) app. NIATx: Network for the Improvement of Addiction Treatment.
Figure 3
Figure 3
Patients' average days of use of RISE Iowa (Recovering Iowans Supporting Each Other) app. NIATx: Network for the Improvement of Addiction Treatment.

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