Using Decision Support Information to Improve System Performance Peter F. Luongo, Ph.D. March 20, 2008

Treatment Effectiveness Alcohol and Drug dependent people who participate in drug treatment Decrease substance use Decrease criminal activity Increase employment Improve their social and intrapersonal functioning Improve their physical health Drug use and criminal activity ⇓⇓ for virtually all who enter treatment   results the longer they stay in treatment.

Statewide Maryland Automated Record Tracking (SMART) SMART is a full electronic clinical record (EHR) All funded treatment providers report data online SMART addresses key EHR concerns: Admission, treatment encounters and discharge Privacy, Practitioner control, Administrative oversight Interoperability = shares information through XML Additional Modules eCourt Contract Monitoring and Billing

Merged Core Programming with National Web Infrastructure for Treatment Services (WITS) Application Created a Maryland Branch with Maryland Specific programming modules Future programming from the National Application is shared with Maryland and ADAA will make Maryland specific modules available to other WITS user jurisdictions Stand Alone Data Analyzer Ready for deployment and training Real time access to data Providers Jurisdiction decision makers State oversight (ADAA) Statewide Maryland Automated Record Tracking (SMART)

Under development Automated Drug Testing – May 2008 Additional Clinical Assessments and Screening Homicide and suicide lethality assessments HIV and TB risk assessments Many Others

What do Substance Abuse Systems Need To Do? Standardize Patient Assessments Standardize Patient Placement Criteria Standardize Performance Measures Ensure Data Validity and Reliability Publish the Data Ask What It Means

Referral Tracking Fiscal Year 2006 Discharges ASAM Referred From Referred Patients Subsequent Admission Within 90 Days Concurrent Admission Never Discharged From No Record Found within 90 Days Actual ASAM Referred To Different ASAM Than ASAM Referred To Level %316.7%00.0%1372.2% Level I %209.3%00.0% % Level II %618.8%00.0%2165.6% Level III %421.1%00.0%1368.4% Level III %9733.6%51.7% % Level III.7.D9111.1%333.3%00.0%555.6% Total % %50.9% % Discharges that have been referred or transferred to another level of care using the treatment referral type field Concurrent admission was never discharged from = the case came to the current level of care from a previous treatment episode that was not closed. The client presumably returned to the previous treatment episode and level of care

Referral Tracking Fiscal Year 2007 Discharges ASAM Referred From Referred Patients Subsequent Admission Within 90 Days Concurrent Admission Never Discharged From No Record Found within 90 Days Actual ASAM Referred To Different ASAM Than ASAM Referred To Level %17.1%00.0%1392.9% Level I %1614.4%10.9%7971.2% Level II %928.1%00.0%1340.6% Level III %36.0% % Level III %4415.3%62.1% % Level III.7.D %313.0%14.3%730.4% Total %7614.7%112.1% % Discharges that have been referred or transferred to another level of care using the treatment referral type field Concurrent admission was never discharged from = the case came to the current level of care from a previous treatment episode that was not closed. The client presumably returned to the previous treatment episode and level of care

Referral Tracking – 2006 vs 2007 Fiscal Year Discharges ASAM Referred From Referred Patients Subsequent Admission Within 90 Days Concurrent Admission Never Discharged From No Record Found within 90 Days Actual ASAM Referred To Different ASAM Than ASAM Referred To Level %316.7%00.0%1372.2% %17.1%00.0%1392.9% Level I %209.3%00.0% % %1614.4%10.9%7971.2% Level II %618.8%00.0%2165.6% %928.1%00.0%1340.6% Level III %421.1%00.0%1368.4% %36.0% % Level III %9733.6%51.7% % %4415.3%62.1% % Level III.7.D %333.3%00.0%555.6% %313.0%14.3%730.4%