Prioritising measures to assess performance of drug treatment services: perspectives of funders, treatment providers and service users

Background: Whilst many studies have looked at outcome measurement as part of clinical trials and routine outcome collection at the person-level, there has been limited studies exploring the measures required to assess the performance of treatment at the service-level. In Australia, non-government services are primarily funded by government using public funds, however there is no standardised approach to performance measurement. This study sought to understand what is important to measure from the perspectives of funders, treatment providers and service users.

Method: A three-round Delphi procedure was conducted with (i) funders of treatment (n=10), (ii) treatment providers (n=10), (iii) treatment service users (n=10). Each round was administered via email with participants asked to rate the same measures on a 10-point Likert scale on how important they were to be included in contracts with funders. Measures with a mean score >7 and agreement among participants above 70% were the criteria to be considered as part of final set of measures. Content analysis was used for qualitative data from the rationales provided by participants for their ratings in round one and two.

Results: Fourteen service level measures and two system level measures met criteria for consideration as a final set of performance measures for services. This was achieved from participants rating 93 measures in round one, which reduced to 78 measures in round two, and finally 32 measures rated in round three. The final set of measures cover a range of measurement types: outcomes (n=3), experience (n=3), access (n=3), structural (n=3), input (n=2), process (n=1), output (n=1).

Conclusion: The study results provide an opportunity to standardise assessment of performance for drug treatment. They have the potential to demonstrate accountability for public funds, an opportunity for service improvement, and highlight key measures of success to future services users and the broader community.