Editor's note: Established in 2001, the James W. West, MD, Quality Improvement Awards recognize member organizations of the National Association of Addiction Treatment Providers (NAATP) that improve the quality and effectiveness of their services and document their results along the way.
The award is named in honor of James W. West, a longtime quality improvement advocate and medical director emeritus at the Betty Ford Center. Award recipients will be honored at the annual NAATP conference, held May 19-22 in Phoenix.
This, the 12th annual award, recognizes three programs whose efforts demonstrate comprehensive approaches to effective, continuous quality improvement. One of three recipients this year, Glendale Adventist Alcohol & Drug Services was recognized for maintaining its comprehensive data collection efforts over a 10-year span.
Over 20 years ago, Glendale Adventist Alcohol and Drug Services (GAADS), a division of Glendale Adventist Medical Center, conducted a few “sporadic” studies that evaluated quality of care using metrics beyond typical demographics. While these didn’t make an immediate impact in terms of improving patient outcomes, it did accomplish one important thing—they got management thinking.
First, Glendale partnered with researchers from UCLA on a more in-depth study, which program director Scott Robertson says helped them understand the need to go beyond “performance measurement.” That led to hiring a third-party to provide a level of unbiased reporting that’s often difficult to achieve in house.
“It’s easy to lose your objectivity when you’re focusing your own work, so we wanted to have a third-party administer it for us,” explains Robertson. “Not only does it provide a fresh look at things in an ongoing way, it gives us the ability to be surprised.”
The third-party vendor administers a data collection system called BASIS-32, a system validated in both inpatient and outpatient settings to provide an objective look at quality improvement both in terms of clinical outcomes and patient satisfaction.
The tool assesses treatment outcomes from the patient perspective by accumulating 32 indicators from patients at both at admission and at discharge. An overall score is given with five subscales for domains of psychiatric and substance abuse symptoms and functioning, which include:
- Relation to self and others
- Depression and anxiety
- Daily living and role functioning
- Impulsive and addictive behavior
In the 10 years GAADS has been sending the monthly questionnaires to the third-party service, over 2,000 patients have participated. Each staff member is trained to offer the survey to incoming patients, while a trained volunteer sends them to the vendor. Results are not seen by anyone else at the facility to prevent potential bias.
“It isn’t advertising or marketing materials, or self administered performance improvement data,” Robertson says. “The data can’t be tainted; it has to be quantifiable and verifiable.” In addition, quarterly reports are published online, which he says provides a level of accountability and transparency that are “essential” to a culture of quality.
Every year, Glendale completes a special project that “drills into the data” and focuses on a subset of patients. Demographics such as age and gender are often used to understand how outcomes and patient satisfaction vary between men and women, as well as patients at different stages of life.
One example suggested that women might benefit from gender-separated services. Female clients responded well, but 10 years ago it might not have happened. “I might have thought it [was a good idea] and had anecdotal evidence, but I wouldn’t have had the data to support it,” Robertson explains. “Now, data confirms the directions we take.”
The data also serves to confirm something that most addiction professionals never really know for certain—whether they are actually making a difference. Stemming from the principle of doing “meaningful work,” Robertson says that having a method to cultivate the passion for patient care is “the only way that quality happens.”
By having “proof” that the services provided improve the lives of patients, he says staff are able to know they are helping their patients—and not simply hope that they are. “I’m able to give our staff feedback that helps them experience how meaningful their work really is,” he says.
Dennis Gilhousen, president and CEO of NAATP, says Glendale’s efforts to collect outcomes data is something that “everyone does to some degree.” However, many end up putting this kind of statistical data aside and forgetting about it, he points out. “Glendale didn’t do that.”
“What makes this different is the way they did it and the tenacity they had in pursuing it,” explains Gilhousen. “To maintain that sort of program over a 10-year period and continue to use it over that time is a remarkable thing.”
Photo caption: Leaders of the Glendale Adventist Alcohol & Drug Services (GAADS) quality improvement initiative are (l-r) Valena Emery, director of organizational performance; Gary Mittelberg, administrative director of behavioral medicine; and Scott Robertson, program director.