DoubleTree Hotel
Rockville, Maryland
March 5, 1998

Peter Delany, D.S.W.
Deputy Chief, Services Research Branch
Division of Clinical and Services Research

Summary

Meeting Goals

• Offer guidance to NIDA’s health services research agenda in the area of organization and management of drug abuse treatment and prevention
  
• Propose strategies to recruit and train new investigators in the field
  
• Determine agenda items for the NIDA meeting, Forging the Link: Health Services Research on Drug Abuse Prevention and Treatment, preceding the Annual Meeting of the Association for Health Services Research in June 1998

Meeting Process

The chair of the meeting, Thomas D’Aunno, Ph.D., provided a conceptual framework for setting meeting priorities, and Aaron De Smet, MBA, presented information on helping organizations adapt to a changing environment. Participants discussed research priorities in the environmental, organizational-environmental, and internal organization domains to develop a plan for NIDA’s health services research agenda. The meeting also addressed strategies to expand the pool of researchers in this area.

Content

The following points were highlighted to help organizations adapt to changing environments:

• Drug abuse treatment organizations are not known for innovation and adaptation
• More understanding is needed about the impact of treatment
• Organizations need to be flexible, yet retain clearly defined boundaries
• Control mechanisms other than market feedback are needed for bureaucratic organizations to be efficient

Five levels of organizational functioning were named:

• Static input-output mechanisms
• Simple control systems
• Complex control systems
• Self-improving systems
• Adaptive systems

The following research priorities in the environmental domain were identified:

• Study organizational forms that combine functions of treatment control and financing
• Investigate emerging organizational forms and linkages and their differences
• Perform cross-level analysis and level of analysis
• Distinguish between vertically and horizontally embedded forms
• Determine why management is dissimilar in vertical relationships
• Enhance understanding of the complex interplay of mission, financing, and ownership
• Evaluate direct provision versus contracting of treatment services and the selection of different combinations
• Study whether prevention and treatment can be combined in the same organizational delivery system
• Investigate competing value systems
• Explore evolutionary versus revolutionary change for organizations/systems and effectiveness as a function of or response to environment and financing

Determine the incentives and disincentives for prevention in managed care:
• Payment
• Role of specialists
• Cost-effectiveness
• Cost offsets
• Study private-sector innovations adapted in the public sector
• Determine where we can intervene and test models

Meeting participants discussed the following issues surrounding organizational-environmental links:

• Define success and failure in drug abuse treatment and prevention
• Study treatment program closure rates and reasons that providers have not adapted to change
• Explore the composition of organizations’ governing boards and their records for attracting resources
• Study intervention models for links to a continuum of comprehensive services and financing
• Evaluate case findings, intake and referral procedures, screening, and case management
• Investigate carve-outs and carve-ins: What are the linkage mechanisms and can they be developed?
• Research ways organizations make decisions and how they obtain or manage contracts
• Understand issues of accreditation and quality signals
• Evaluate formal versus informal organizational operations and linkages and levels of variance
• Study the role of social service agencies and links to prevention organizations and treatment providers
• Explore management information systems and privacy, especially of employees

The following research issues were named in the internal organizational domain:

• Study treatment staff issues, including training, job satisfaction, attitudes, productivity, mobility, incentives, turnover, evaluation, rewards, and the relationship between expectations and outcomes   
• Explore the differences in uniform versus tailored treatment programs
• Study the issue of integrating services in managed care to reduce cost-shifting
• Gain an understanding of organizations that are quick adapters and the structures that are important
• Explore the use of wait lists as screening mechanisms and for treatment motivation
• Investigate HMO/MCO incentives for long-term client relationships that emphasize prevention
• Study special populations, including rural areas, discriminatory access to treatment, and disparities in service provision
• Explore the advantages, disadvantages, and differences in large and small organizations
• Determine how small organizations form larger ones through links, mergers, and consortia   
• Study the issue of comorbidity and its effect on organizations, assessment, and linkages
• Research the impact of program siting and outreach services on access and utilization
• Investigate funding mechanisms, including the role of subsidized treatment programs in the adaptability of organizations

In order to expand the pool of researchers, the following strategies were introduced:

• Determine barriers and advantages to attracting existing researchers versus developing them within the field
• Promote "road shows" to universities as a targeted marketing strategy
• Encourage use of conference grants to convene researchers with a range of experience
• Target mainstream journals and membership organizations for greater visibility of drug abuse research issues
• Consider small setaside grants to fund young researchers

Products and Follow-Up

• Two panels will be formed for the NIDA-sponsored meeting, Forging the Link: Health Services Research on Drug Abuse Prevention and Treatment, to be held in conjunction with the Annual Meeting of the Association for Health Services Research in June 1998. Individuals will be selected to present issues in organization and management in the following areas:
• State of the science
• Future research directions
• Meeting participants are encouraged to attend the NIDA meeting, which will be held June 20, 1998.
• Selected members of the group may be contacted to help prioritize agenda items or to develop follow-up materials.