Patient Feedback: A Quality Improvement Study in Outpatient Settings

• Reduction of drug and alcohol use [ Time Frame: Weeks 1-12 ] [ Designated as safety issue: No ]
  

• Patient ratings of therapeutic alliance [ Time Frame: Weeks 1-12 ] [ Designated as safety issue: No ]
  
• Patient ratings of treatment satisfaction [ Time Frame: Weeks 1-12 ] [ Designated as safety issue: No ]
  
• Quality of clinician/supervisor interactions [ Time Frame: Baseline (week 1) and week 12 ] [ Designated as safety issue: No ]
  
• Patient attendance [ Time Frame: Weeks 1-12 ] [ Designated as safety issue: No ]
  

Using clinician performance data obtained from the PF Survey, patient attendance data, and staff measures, we propose to achieve the following specific aims:

1. Primary Objective Determine the degree to which there is a reduction in drug and alcohol use for the experimental condition clinicians examining baseline (week 1) to end of treatment (week 12), relative to the drug and alcohol use of patients in the corresponding control condition clinicians' caseload.
2. Secondary Objective #1 Determine the degree to which clinicians' average patient ratings of therapeutic alliance in the PF condition improve, as compared to those in the control condition.
3. Secondary Objective #2 Determine the degree to which clinicians' average patient ratings of treatment satisfaction in the PF condition improve, as compared to those in the control condition.
4. Secondary Objective #3 Determine the degree to which the quality of clinician/supervisor interactions in the PF condition improves compared to those of staff in the control condition.
5. Secondary Objective #4 When applicable and the data is available, determine the degree to which clinicians' average patient attendance in the PF condition improves during the Intervention Phase of the study, as compared to average patient attendance for clinicians in the control condition.

The primary endpoints to be measured in this study include:

1. Levels of patient drug and alcohol use per clinician. Patients report their own substance abuse within the past week on items 11 and 12 of the PF survey. The weekly averaged drug and alcohol use, averaged for all patients (and for the subset of patients in treatment for 1 month or less) for each clinician, will be used.

The secondary endpoints to be measured in this study include:

1. Therapeutic Alliance. Ratings of therapeutic alliance are measured by items 1-4 on the PF survey. Measures are obtained on the same assessment schedule as the measures for the primary endpoint. Average patient alliance scores for each clinician are calculated and used as a dependent variable.
2. Treatment Satisfaction. Ratings of treatment satisfaction are measured by items 5-7 on the PF survey. Measures are obtained on the same assessment schedule as the measures for the primary endpoints. Average patient treatment satisfaction ratings for each clinician are calculated and used as a dependent variable.
3. Quality of clinician/supervisor interactions. Clinician/supervisor interactions measures are obtained from a total average of the LMX-7 measure, at the pre- and post-intervention time points.
4. Patient Attendance rates per clinician. A member of the clinic support staff extracts attendance data from the clinic's administrative record and enters those data on to the Attendance Form (see Appendix A). Attendance rates will be calculated as the average weekly proportion of scheduled sessions attended by the patients assigned to each clinician during each of the 12 weeks of the intervention phase. Averages for all patients, and for the subset of patients who have been in treatment for 1 month or less, will be calculated.

The study consists of a pre-intervention phase lasting several weeks and an intervention phase lasting 12 weeks (or as many weeks as is necessary to collect 12 assessments, noting that clinic closures may occur for holidays, etc.). A final optional sustainability phase examines clinic use of the PF system over a one year period. Individual clinics will be initiated on a rolling enrollment basis, in three cohorts of 10-12 clinics each.