Using technology to digitally disrupt the delivery of outcome measures in Alcohol and Other Drug (AOD) services

The demand for AOD treatment in Australia greatly outweighs the available resources. Consequently, AOD services tend to prioritize the volume of AOD service delivery over quality. Value-based Healthcare (VBHC) which shifts the focus away from the volume of service delivery towards client outcomes, provides a potential solution to these problems. The implementation of Core Outcome Measures (COMs) is the cornerstone of VBHC. However, relatively few efforts to implement COMs have succeeded due to the challenges involved. This presentation describes how technology has been used to increase the uptake and completion of COMs in AOD services.

Over the past 5 years we worked in partnership with Lives Lived Well (LLW) a large AOD service in Australia to identify a standard set of COMs, and address individual, organizational and system barriers to their adoption. A novel online system was developed to collect COM data directly from clients at service entry, 1 and 3 months follow up.

The COM system was implemented into 167 LLW programs across 426 staff in April 2020. Clients had completed a total of 16,044 COMs by the end of September 2021. The majority of COMS were completed at service entry (61%), with only 29% and 10% of these completed at 1 and 3 months follow up respectively. However, high completion rates were found among clients who were sent COMs at baseline (86%), one (60%) and three (40%) months. On average clients completed baseline COMs within 1-2 days of receiving them. A discrete choice experiment is currently being conducted to identify strategies for increasing COM completion (e.g., cliente feedback, progress mapping) at follow up.

The implementation of an online client COM system had a large impact on the capacity of LLW services to assess client outcomes. The impact of this on the efficiency, efficacy and cost-effectiveness of AOD services is currently being evaluated.