Increasing Substance Use Disorder Treatment Retention: A Pilot Study Measuring the Impact of a Clinical Dashboard Tool

Background: Opioid use disorder (OUD) has reached epidemic proportions in the US with more than 200,000 cases reported annually. In a 2018 published report, 11.8 million people, aged 12 and older, reported having misused opioids. Of these, 2.1 million acquired a DSM–5 OUD in one year. Consequently, in 2019 72,000 Americans’ deaths occurring directly from a drug overdose and OUD. Unfortunately, most people who seek professional OUD treatment do not complete their planned care, dropping out within a few weeks after admission. Most of the 1.6 million professional therapists in the US who offering services have large caseloads to monitor, relying mainly on their judgments and intuitions rather than a reliable tool to improve patient retention. Clinical dashboards can provide pertinent patient information in a timely manner and improve decision-making and quality of care

Methods: This project’s lead author and a technology startup company developed the platform that allows therapists to register their caseload of patients with vital information. After caseload upload, therapists can see at-a-glance summaries of their patient statuses and overall demographics, along with other variables related to treatment drop out risks. This allows therapists a better understanding of entire caseloads, patient health and recovery path. All therapists (n=6) employed at one outpatient treatment location were trained to use the clinical dashboard and to track patient sessions quantitatively using our software. Critically, the therapists were instructed to use the metrics tracked by the dashboard as a way to structure every patient counseling session and target interventions based on patient self-assessed recovery measures.

Results: We chose to measure successful discharge percentage because it is a reliable quantitative measure and is decided by clinical staff rather than individual therapists. Successful discharge is defined as “Discharged with Staff Approval”, which means the patient, clinical team, and supervisor concurred that the patient had made significant progress towards recovery met treatment plan goals. Though our system also tracked discharge reasons, we extracted 10-months of discharge data from clinic’s electronic health records data from clinic’s system, ensuring reliable data for analysis. During that period, the clinic discharged 1306 patients. We officially on-boarded therapists into our system in March of 2019. In the 6 months prior, deemed the control, the discharge with staff approval percentage averaged around 11%. During the four months after dashboard adoption, successful discharge rate more than doubled to 27%. We also received discharge data for other clinics operated by the partner organization. We confirmed those clinics did not show a similar improvement trend compared to our results.

Discussion: Our pilot study demonstrated that treatment retention outcomes can improve by having therapists pay attention to quantitative patient performance measures and by having regular discussions with the therapists about tool’s use. These outcomes were achieved through the foundational features of the tech tool and by therapists who provided services that were guided by real patient data, rather than good intentions and unreliable intuitions.