Thomas D'Aunno
Thomas D'Aunno
Scroll
Professor of Public Health, NYU School of Global Public Health
Professor of Management, NYU Wagner Graduate School of Public Service
-
Professional overview
-
Thomas D'Aunno, Ph.D., is Professor of Management at New York University’s Wagner Graduate School of Public Service and Professor of Public Health at NYU’s School of Global Public Health. His research interests include institutional theory, organizational change, and the performance of healthcare organizations. D’Aunno was previously a faculty member at Columbia University, the University of Chicago, the University of Michigan, and INSEAD, where he held the Novartis Chair in Healthcare Management. He is published in leading management and health journals, including Administrative Science Quarterly, the Academy of Management Journal, Academy of Management Review, Annals of the Academy of Management, the Journal of the American Medical Association, Milbank Quarterly, American Journal of Public Health and Health Affairs. He served as Editor-in-Chief of Medical Care Research and Review, 2014-2018. He also is a past chair of the Academy of Management Division of Health Care Management, and a recipient of its Provan Award for distinguished career contributions to research in healthcare management and the Fottler award for distinguished service to the field.
-
Education
-
Ph.D., Organizational Psychology, University of Michigan, Ann Arbor, MichiganUniversity of Maryland, Community-Clinical Psychology, Baltimore County, MarylandB.A., Psychology, Magna Cum Laude, University of Notre Dame, Notre Dame, Indiana
-
Publications
Publications
Lessons from New York City's Response to the Coronavirus Pandemic
AbstractD’Aunno, T., D’Aunno, T., & D'Aunno, T. (n.d.).Publication year
2020Journal title
MecosanIssue
113Page(s)
309-312AbstractBy March of 2020, it became clear that New York City (NYC) would become the next major urban center in the world to suffer not only from the Coronavirus pandemic, but also from missteps in response to this world-wide crisis. This essay aims to draw lessons from our experience in NYC that might be immediately useful for decision-makers facing similar circumstances and future disasters of this type that are sure to follow.Patient-centered care's relationship with substance use disorder treatment utilization
AbstractD’Aunno, T., D’Aunno, T., Park, S. (., Mosley, J. E., Grogan, C. M., Pollack, H. A., Humphreys, K., D'Aunno, T., & Friedmann, P. D. (n.d.).Publication year
2020Journal title
Journal of Substance Abuse TreatmentVolume
118AbstractBackground: Calls for more patient-centered care are growing in the substance use disorder (SUD) treatment field. However, evidence is sparse regarding whether patient-centered care improves access to, or utilization of, effective treatment services. Methods: Using nationally representative survey data from SUD treatment clinics in the United States, we examine the association between patient-centered clinical care and the utilization of six services: methadone, buprenorphine, behavioral treatment, routine medical care, HIV testing, and suicide prevention counseling. We measured clinics' practice of and emphasis on patient-centered care with two variables: (1) whether the clinic regularly invites patients into clinical decision-making processes, and (2) whether supervisors believe in patient-centered healthcare and shared decision-making practices within their clinics. Results: In 2017, only 23% of SUD treatment clinics regularly invited patients into care decision-making meetings when their cases were discussed. A composite variable captured clinical supervisors' own experience with and expectations for patient-clinician interaction within their clinics (Cronbach's alpha = 0.79). Results from regression models that controlled for several organizational and environmental factors show that patient-centered care was independently associated with greater utilization of four of six evidence-based services. Conclusions: A minority of SUD clinics practice patient-centered healthcare in the United States. Given the connection to evidence-based services, increasing participatory mechanisms in SUD treatment service provision can facilitate patients' access to appropriate and evidence-based services.Stability in a large drug treatment system : Examining the role of program size and performance on service discontinuation
AbstractD’Aunno, T., D’Aunno, T., Guerrero, E. G., Alibrahim, A., Howard, D. L., Wu, S., & D'Aunno, T. (n.d.).Publication year
2020Journal title
International Journal of Drug PolicyVolume
86AbstractBackground: Little is known about the stability of public drug treatment in the United States to deliver services in an era of expansion of public insurance. Guided by organizational theories, we examined the role of program size, and performance (i.e., rates of treatment initiation and engagement) on discontinuing services in one of the largest treatment systems in the United States. Methods: This study relied on multi-year (2006–2014) administrative data of 249,029 treatment admission episodes from 482 treatment programs in Los Angeles County, CA. We relied on survival regression analysis to identify associations between program size, treatment initiation (wait time) and engagement (retention and completion rates) and discontinuing services in any given year. We examined program differences between discontinued versus sustained services in pre- and post-expansion periods. Results: Sixty-two percent of programs discontinued services at some point between 2006 and 2014. Program size and rates of treatment retention were negatively associated with risk of discontinuing services. Proportion of female clients was also negatively associated with risk of discontinuing services. Compared to residential programs, methadone programs were associated with reduced likelihood of discontinuing services. Two interactions were significant; program size and retention rates, as well as program size and completion rates were negatively associated with risk of discontinuing services. Conclusions: Program size (large), type (methadone), performance (retention) and client population (women) were associated with stability in this drug treatment system. Because more than 70% of programs in this system are small, it is critical to support their capacity to sustain services to reduce existing disparities in access to care. We discuss the implications of these findings for system evaluation and for responding to public health crises.Evidence-based treatment for opioid use disorders : A national study of methadone dose levels, 2011–2017
AbstractD’Aunno, T., D’Aunno, T., D'Aunno, T., Park, S. (., & Pollack, H. A. (n.d.).Publication year
2019Journal title
Journal of Substance Abuse TreatmentVolume
96Page(s)
18-22AbstractThe nation's methadone maintenance treatment (MMT) programs play a central role in addressing the current opioid epidemic. Considerable evidence documents the treatment effectiveness of MMT and, in turn, the importance of adequate dosing to MMT's effectiveness. Yet, as recently as 2011, 41% of patients received doses below the level of 80 mg/day. Using survey data from a nationally representative sample of MMT programs in 2011 and 2017, we examine (1) the extent to which the nation's MMT programs are meeting evidence-based standards for methadone dose level and (2) characteristics of MMT programs that are associated with variation in performance. Our results show that 43% of MMT patients receiveMedicaid coverage in substance use disorder treatment after the affordable care act
AbstractAndrews, C. M., Pollack, H. A., Abraham, A. J., Grogan, C. M., Bersamira, C. S., D’Aunno, T., D’Aunno, T., & Friedmann, P. D. (n.d.).Publication year
2019Journal title
Journal of Substance Abuse TreatmentVolume
102Page(s)
1-7AbstractThe Affordable Care Act (ACA) prompted sweeping changes to Medicaid, including expanding insurance coverage to an estimated 12 million previously uninsured Americans, and imposing new parity requirements on benefits for behavioral health services, including substance use disorder treatment. Yet, limited evidence suggests that these changes have reduced the number of uninsured in substance use disorder treatment, or increased access to substance use disorder treatment overall. This study links data from a nationally-representative study of outpatient substance use disorder treatment programs and a unique national survey of state Medicaid programs to capture changes in insurance coverage among substance use disorder treatment patients after ACA implementation. Medicaid expansion was associated with a 15.7-point increase in the percentage of patients insured by Medicaid in substance use disorder treatment programs and a 13.7-point decrease in the percentage uninsured. Restrictions in state Medicaid benefits and utilization policies were associated with a decreased percentage of Medicaid patients in treatment. Moreover, Medicaid expansion was not associated with a change in the total number of clients served over the study period. Our findings highlight the important role Medicaid has played in increasing insurance coverage for substance use disorder treatment.Motivating people
AbstractD’Aunno, T., D’Aunno, T., & Gilmartin, M. (n.d.). (L. Burns, E. Bradley, & B. Weiner, Eds.; 7th ed.).Publication year
2019Abstract~Sustaining multistakeholder alliances
AbstractD’Aunno, T., D’Aunno, T., D'aunno, T., Hearld, L., & Alexander, J. A. (n.d.).Publication year
2019Journal title
Health Care Management ReviewVolume
44Issue
2Page(s)
183-194AbstractBackground: Multistakeholder alliances that bring together diverse organizations to work on community-level health issues are playing an increasingly prominent role in the U.S. health care system. Yet, these alliances by their nature are fragile. In particular, low barriers to exit make alliances particularly vulnerable to disruption if key stakeholders leave. What factors are linked to the sustainability of alliances? One way to approach this question is to examine the perceptions of alliance participants, whose on-going involvement in alliances likely will matter much to their sustainability. Purpose: This study addresses the question: "Under what conditions do participants in alliances consider that their alliances are well positioned for the future, will perform well over time, and will be able to deal effectively with future challenges?" Methods: We draw on cross-sectional survey data collected in the summer of 2015 from a total number of 638 participants in 15 alliances that participated in the Robert Wood Johnson Foundation's Aligning Forces for Quality program. Results: Results from regression analyses indicate that alliance participants are more likely to view their alliances as sustainable when they (a) share a common vision, goals, and strategies for the alliance and (b) perceive that the alliance has performed effectively in the past. Practice Implications: Leaders of multistakeholder alliances may need to ensure that alliances are collective efforts that build success one step at a time: to the extent that participants believe they share a vision and strategies and have had some prior success working together, the more likely they are to view the alliance as sustainable.The relationship of Medicaid expansion to psychiatric comorbidity care within substance use disorder treatment programs
AbstractD’Aunno, T., D’Aunno, T., Shover, C. L., Abraham, A. J., D'Aunno, T., Friedmann, P. D., & Humphreys, K. (n.d.).Publication year
2019Journal title
Journal of Substance Abuse TreatmentVolume
105Page(s)
44-50AbstractBackground: Co-occurring mental health disorders are common among substance use disorder (SUD) patients. Medicaid expansion aimed to reduce barriers to SUD and mental health care and thereby improve treatment outcomes. Methods: We estimated change in the proportion of United States SUD treatment sites offering treatment for psychiatric comorbidities following Medicaid expansion as part of implementation of the Affordable Care Act (ACA) in 2014. Using panel data from the 2013–2014, n = 660, and 2016–2017, n = 638, waves of the National Drug Abuse Treatment System Survey (NDATSS), we estimated change in the proportion of sites offering antidepressant medication, other psychiatric medication, behavioral treatment, or any combination thereof for treatment of mental health comorbidities (i.e., beyond services focused on SUD). We modeled the impact of Medicaid expansion as an interaction between year and date of Medicaid expansion. We constructed a mixed-effects linear regression model for each outcome, with the interaction variable as the main exposure, site as a random effect, and site's average duration of treatment, proportion of clients with psychiatric comorbidities, average caseload per treatment prescribing-clinician on staff, type of facility and geographic region as covariates, to estimate a difference-in-differences (D-I-D) equation. Results: The adjusted D-I-D analysis indicated that the proportion of SUD treatment sites offering antidepressants for psychiatric treatment increased 10% (95% CI 1%, 18%) in the Medicaid expansion sites compared to non-expansion sites. The D-I-D for other psychiatric medications was also 10% (95% 1%, 19%). No significant changes were observed in behavioral treatment or the combination measure. The strongest association between Medicaid expansion and offering medication for mental health comorbidities was the 34% increase observed for residential treatment settings (95% CI 10%, 59%). Conclusion: Availability of psychiatric medication treatment in SUD treatment settings increased following Medicaid expansion, particularly in residential SUD facilities. This policy change has facilitated integrated treatment for the substantial share of SUD treatment patients with mental health comorbidities, with the greatest benefit for patients receiving SUD treatment in residential programs.Do benefits restrictions limit Medicaid acceptance in addiction treatment? : Results from a national study
AbstractD’Aunno, T., D’Aunno, T., Andrews, C. M., Grogan, C. M., Westlake, M. A., Abraham, A. J., Pollack, H. A., D'Aunno, T., & Friedmann, P. D. (n.d.).Publication year
2018Journal title
Journal of Substance Abuse TreatmentVolume
87Page(s)
50-55AbstractObjective: To assess the relationship of restrictions on Medicaid benefits for addiction treatment to Medicaid acceptance among addiction treatment programs. Data sources: We collected primary data from the 2013–2014 wave of the National Drug Abuse Treatment System Survey. Study design: We created two measures of benefits restrictiveness. In the first, we calculated the number of addiction treatment services covered by each state Medicaid program. In the second, we calculated the total number of utilization controls imposed on each service. Using a mixed-effects logistic regression model, we estimated the relationship between state Medicaid benefit restrictiveness for addiction treatment and adjusted odds of Medicaid acceptance among addiction treatment programs. Data collection: Study data come from a nationally-representative sample of 695 addiction treatment programs (85.5% response rate), representatives from Medicaid programs in forty-seven states and the District of Columbia (response rate 92%), and data collected by the American Society for Addiction Medicine. Principal findings: Addiction treatment programs in states with more restrictive Medicaid benefits for addiction treatment had lower odds of accepting Medicaid enrollees (AOR = 0.65; CI = 0.43, 0.97). The predicted probability of Medicaid acceptance was 35.4% in highly restrictive states, 48.3% in moderately restrictive states, and 61.2% in the least restrictive states. Conclusions: Addiction treatment programs are more likely to accept Medicaid in states with less restrictive benefits for addiction treatment. Program ownership and technological infrastructure also play an important role in increasing Medicaid acceptance.Factors That Distinguish High-Performing Accountable Care Organizations in the Medicare Shared Savings Program
AbstractD’Aunno, T., D’Aunno, T., D'Aunno, T., Broffman, L., Sparer, M., & Kumar, S. R. (n.d.).Publication year
2018Journal title
Health Services ResearchVolume
53Issue
1Page(s)
120-137AbstractObjective: To identify factors that promote the effective performance of accountable care organizations (ACOs) in the Medicare Shared Savings Program. Data Sources/Study Setting: Data come from a convenience sample of 16 Medicare Shared Savings ACOs that were organized around large physician groups. We use claims data from the Center for Medicaid and Medicare Services and data from 60 interviews at three high-performing and three low-performing ACOs. Study Design: Explanatory sequential design, using qualitative data to account for patterns observed in quantitative assessment of ACO performance. Data Collection Methods: A total of 16 ACOs were first rank-ordered on measures of cost and quality of care; we then selected three high and three low performers for site visits; interview data were content-analyzed. Principal Findings: Results identify several factors that distinguish high- from low-performing ACOs: (1) collaboration with hospitals; (2) effective physician group practice prior to ACO engagement; (3) trusted, long-standing physician leaders focused on improving performance; (4) sophisticated use of information systems; (5) effective feedback to physicians; and (6) embedded care coordinators. Conclusions: Shorter interventions can improve ACO performance—use of embedded care coordinators and local, regional health information systems; timely feedback of performance data. However, longer term interventions are needed to promote physician–hospital collaboration and skills of physician leaders. CMS and other stakeholders need realistic timelines for ACO performance.State-Targeted funding and technical assistance to increase access to medication treatment for opioid use disorder
AbstractD’Aunno, T., D’Aunno, T., Abraham, A. J., Andrews, C. M., Grogan, C. M., Pollack, H. A., D’Aunno, T., Humphreys, K., & Friedmann, P. D. (n.d.).Publication year
2018Journal title
Psychiatric ServicesVolume
69Issue
4Page(s)
448-455AbstractObjective: As the United States grapples with an opioid epidemic, expanding access to effective treatment for opioid use disorder is a major public health priority. Identifying effective policy tools that can be used to expand access to care is critically important. This article examines the relationship between state-targeted funding and technical assistance and adoption of three medications for treating opioid use disorder: oral naltrexone, injectable naltrexone, and buprenorphine. Methods: This study draws from the 2013–2014 wave of the National Drug Abuse Treatment System Survey, a nationally representative, longitudinal study of substance use disorder treatment programs. The sample includes data from 695 treatment programs (85.5% response rate) and representatives from single-state agencies in 49 States and Washington, D.C. (98% response rate). Logistic regression was used to examine the relationships of single-state agency targeted funding and technical assistance to availability of opioid use disorder medications among treatment programs. Results: State-targeted funding was associated with increased program-level adoption of oral naltrexone (adjusted odds ratio [AOR]=3.14, 95% confidence interval [CI]=1.49–6.60, p=.004) and buprenorphine (AOR=2.47, 95% CI=1.31–4.67, p=.006). Buprenorphine adoption was also correlated with state technical assistance to support medication provision (AOR=1.18, 95% CI=1.00–1.39, p=.049). Conclusions: State-targeted funding for medications May be a viable policy lever for increasing access to opioid use disorder medications. Given the historically low rates of opioid use disorder medication adoption in treatment programs, single-state agency targeted funding is a potentially important tool to reduce mortality and morbidity associated with opioid disorders and misuse.The Hidden Roles That Management Partners Play in Accountable Care Organizations
AbstractD’Aunno, T., D’Aunno, T., Lewis, V. A., D'Aunno, T., Murray, G. F., Shortell, S. M., & Colla, C. H. (n.d.).Publication year
2018Journal title
Health AffairsVolume
37Issue
2Page(s)
292-298AbstractAccountable care organizations (ACOs) are often discussed and promoted as driven by physicians, hospitals, and other health care providers. However, because of the flexible nature of ACO contracts, management organizations may also become partners in ACOs.We used data from 2013-15 on 276 ACOs from the National Survey of Accountable Care Organizations to understand the prevalence of nonprovider management partners' involvement in ACOs, the services these partners provide, and the structure of ACOs that have such partners. We found that 37 percent of ACOs reported having a management partner, and two-thirds of these ACOs reported that the partner shared in the financial risks or rewards. Among ACOs with partners, 94 percent had data services provided by the partner, 87 percent received administrative services, 68 percent received educational services, and 66 percent received care coordination services. Half received all four of these services from their partner. ACOs with partners were more heavily primary care than other ACOs. ACOs with and without partners had similar performance on costs and quality in Medicare ACO programs. Our findings suggest that management partners play a central role in many ACOs, perhaps supplying smaller and physician-run ACOs with services or expertise perceived as necessary for ACO success.Trust, Money, and Power : Life Cycle Dynamics in Alliances Between Management Partners and Accountable Care Organizations
AbstractD’Aunno, T., D’Aunno, T., Murray, G. F., D'aunno, T., & Lewis, V. A. (n.d.).Publication year
2018Journal title
Milbank QuarterlyVolume
96Issue
4Page(s)
755-781AbstractPolicy Points Accountable care organizations (ACOs) form alliances with management partners to access financial, technical, and managerial support. Alliances between ACOs and management partners are subject to destabilizing tension around decision-making authority, distribution of shared savings, and conflicting goals and values. Management partners may serve either as trainers, ultimately breaking off from the ACO, or as central drivers of the ACO. Management partner participation in ACOs is currently unregulated, and management partners may receive a significant portion (in some cases, majority) of shared savings. Context: Accountable care organizations (ACOs) are a prominent payment and delivery model. Though ACOs are often described as groups of health care providers, nearly 4 in 10 ACOs partner with a management company for services such as financial investment, contracting, data analytics, and care management, according to recent research. However, we know little about how and why these partnerships form. This article aims to understand the reasons providers seek partners, the nature of these relationships, and factors critical to the success or failure of these alliances. Methods: We used qualitative data collected longitudinally from 2012 to 2017 at 2 ACOs to understand relationships between management partners and ACO providers. The data include 115 semistructured interviews and observational data from 7 site visits. Two coders applied 48 codes to the data. We reviewed coded data for emergent themes in the context of alliance life cycle theory. Findings: Qualitative data revealed that management partners brought specific skills and services and also gave providers confidence in pursuing an ACO. Over time, tension between providers and management partners arose around decision-making authority, distribution of shared savings, and conflicting goals and values. We observed 2 outcomes of partnerships: cemented partnerships and dissolution. Key factors distinguishing alliance outcome in these 2 cases include degree of trust between organizations in the alliance; approach to conflict resolution; distribution of power in the alliance; skills and confidence acquired by the ACO over the life of the alliance; continuity of management partner delivery on promised resources; and proportion of savings going to the management partner. Conclusions: The diverging paths for ACOs with management partners suggest 2 different roles that management partners may play in ACO development. In some cases, management partners may serve as trainers, with the partnership dissolving once the ACO gains skills and confidence to work alone. In other cases, the management partner is a central driver of the ACO and unlikely to break off.A behavioral blueprint for improving health care policy
AbstractD’Aunno, T., D’Aunno, T., Loewenstein, G., Hagmann, D., Schwartz, J., Ericson, K., Kessler, J. B., Bhargava, S., Blumenthal-Barby, J., D'Aunno, T., Handel, B., Kolstad, J., & Nussbaum, D. (n.d.).Publication year
2017Journal title
Behavioral Science & PolicyVolume
3Issue
1Page(s)
53-69AbstractBehavioral policy to improve health and health care often relies on interventions, such as nudges, which target individual behaviors. But the most promising applications of behavioral insights in this area involve more far-reaching and systemic interventions. In this article, we propose a series of policies inspired by behavioral research that we believe offer the greatest potential for success. These include interventions to improve health-related behaviors, health insurance access, decisions about insurance plans, end-of-life care, and rates of medical (for example, organ and blood) donation. We conclude with a discussion of new technologies, such as electronic medical records and web- or mobile-based decision apps, which can enhance doctor and patient adherence to best medical practices. These technologies, however, also pose new challenges that can undermine the effectiveness of medical care delivery.Corrigendum to “Evidence-based treatment for opioid disorders : A 23-year national study of methadone dose levels” [Journal of Substance Abuse Treatment 47 (2014) 245–250](S0740547214000907)(10.1016/j.jsat.2014.06.001)
AbstractD’Aunno, T., D’Aunno, T., D'Aunno, T., Pollack, H. A., Frimpong, J. A., Frimpong, J. A., & Wutchiett, D. (n.d.).Publication year
2017Journal title
Journal of Substance Abuse TreatmentVolume
79Page(s)
75AbstractThe authors would like to confirm that the authorship list, as listed above, is correct. The authors would like to apologize for any inconvenience caused.Creating value for participants in multistakeholder alliances : The shifting importance of leadership and collaborative decision-making over time
AbstractD’Aunno, T., D’Aunno, T., D'Aunno, T., Alexander, J. A., & Jiang, L. (n.d.).Publication year
2017Journal title
Health Care Management ReviewVolume
42Issue
2Page(s)
100-111AbstractBackground: Multistakeholder alliances that bring together diverse organizations to work on health-related issues are playing an increasingly prominent role in the U.S. health care system. Prior research shows that collaborative decision-making and effective leadership are related to members' perceptions of value for their participation in alliances. Yet, we know little about how collaborative decision-making and leadership might matter over time in multistakeholder alliances. Purpose: The aim of this study was to advance understanding of the role of collaborative decision-making and leadership in individuals' assessments of the benefits and costs of their participation in multistakeholder alliances over time. Methods: We draw on data collected from three rounds of surveys of alliance members (2007-2012) who participated in the Robert Wood Johnson Foundation's Aligning Forces for Quality program. Findings: Results from regression analyses indicate that individuals' perceptions of value for their participation in alliances shift over time: Perceived value is higher with collaborative decision-making when alliances are first formed and higher with more effective leadership as time passes after alliance formation. Practice Implications: Leaders of multistakeholder alliances may need to vary their behavior over time, shifting their emphasis from inclusive decision-making to task achievement.Evidence-Based Management in Healthcare : Principles, Cases, and Perspectives
AbstractKovner, A. R., D’Aunno, T., & D’Aunno, T. (n.d.). (2nd ed.).Publication year
2017Abstract~Linkages between patient-centered medical homes and addiction treatment organizations
AbstractD’Aunno, T., D’Aunno, T., D'Aunno, T., Pollack, H., Chen, Q., & Friedmann, P. D. (n.d.).Publication year
2017Journal title
Medical careVolume
55Issue
4Page(s)
379-383AbstractBackground: To meet their aims of providing comprehensive and coordinated care, patient-centered medical homes (PCMHs) need to coordinate services for individuals with substance use disorders. Yet, the 14,000 addiction treatment (AT) organizations across the United States that provide services for more than 1 million individuals daily are generally ill-prepared to work with PCMHs (eg, AT organizations often lack electronic health records). Objectives: To examine the extent to which AT organizations have formal linkages through contracts with PCMHs; to identify key dimensions of linkages between PCMHs and AT organizations (eg, shared use of electronic health records); to identify characteristics of AT organizations and their environments associated with these linkages. Materials and Methods: We draw on data from a 2014 nationally representative survey of directors and clinical supervisors from 695 AT organizations (n=1390 survey respondents). Results: Thirty-eight percent of patients across the nation are receiving treatment in AT organizations linked by contracts to PCMHs. This number increases to 51% in states that expanded Medicaid (vs. only 6.2% of patients in non-Medicaid expansion states). Yet, the great majority of linkages are relatively weak; they do not include the exchange of patient information. Results from multivariable analyses show that larger, nonprofit and publicly owned AT organizations, as well as those located in the northeast and in states that expanded Medicaid coverage, are more likely to have contracts with PCMHs. Conclusions: Without stronger linkages between AT organizations and PCMHs or the development of other models that integrate services, individuals with substance abuse disorders may continue to receive uncoordinated care.Practice environments and job satisfaction and turnover intentions of nurse practitioners : Implications for primary care workforce capacity
AbstractD’Aunno, T., D’Aunno, T., Poghosyan, L., Liu, J., Shang, J., & D'Aunno, T. (n.d.).Publication year
2017Journal title
Health Care Management ReviewVolume
42Issue
2Page(s)
162-171AbstractBackground: Health care professionals, organizations, and policy makers are calling for expansion of the nurse practitioner (NP) workforce in primary care to assure timely access and high-quality care. However, most efforts promoting NP practice have been focused on state level scope of practice regulations, with limited attention to the organizational structures. Purpose: We examined NP practice environments in primary care organizations and the extent to which they were associated with NP retention measures. Methodology: Data were collected through mail survey of NPs practicing in 163 primary care organizations in Massachusetts in 2012. NP practice environment was measured by the Nurse Practitioner Primary Care Organizational Climate Questionnaire, which has four subscales: Professional Visibility, NP-Administration Relations, NP-Physician Relations, and Independent Practice and Support. Two global items measured job satisfaction and NPs' intent to leave their job. We aggregated NP level data to organization level to attain measures of practice environments. Multilevel logistic regression models were used. Findings: NPs rated the relationship between NPs and physicians favorably, contrary to the relationship between NPs and administrators. All subscales measuring NP practice environment had similar influence on the outcome variables. With every unit increase in each standardized subscale score, the odds of job satisfaction factors increased about 20% whereas the odds of intention of turnover decreased about 20%. NPs from organizations with higher mean scores on the NP-Administration subscale had higher satisfaction with their jobs (OR = 1.24, 95% CI [1.12, 1.39]) and had lower intent to leave (OR = 0.79, 95% CI [0.70, 0.90]). Practice Implications: NPs were more likely to be satisfied with their jobs and less likely to report intent to leave if their organizations support NP practice, favorable relations with physicians and administration, and clear role visibility. Creating productive practice environments that can retain NPs is a potential strategy for increasing the primary care workforce capacity.The affordable care act transformation of substance use disorder treatment
AbstractD’Aunno, T., D’Aunno, T., Abraham, A. J., Andrews, C. M., Grogan, C. M., Pollack, H. A., D'Aunno, T., Humphreys, K. N., & Friedmann, P. D. (n.d.).Publication year
2017Journal title
American journal of public healthVolume
107Issue
1Page(s)
31-32Abstract~The Role of Program Directors in Treatment Practices : The Case of Methadone Dose Patterns in U.S. Outpatient Opioid Agonist Treatment Programs
AbstractD’Aunno, T., D’Aunno, T., Frimpong, J. A., Frimpong, J. A., Shiu-Yee, K., & D'Aunno, T. (n.d.).Publication year
2017Journal title
Health Services ResearchVolume
52Issue
5Page(s)
1881-1907AbstractObjective: To describe changes in characteristics of directors of outpatient opioid agonist treatment (OAT) programs, and to examine the association between directors’ characteristics and low methadone dosage. Data Source: Repeated cross-sectional surveys of OAT programs in the United States from 1995 to 2011. Study Design: We used generalized linear regression models to examine associations between directors’ characteristics and methadone dose, adjusting for program and patient factors. Data Collection: Data were collected through telephone surveys of program directors. Principal Findings: The proportion of OAT programs with an African American director declined over time, from 29 percent in 1995 to 16 percent in 2011. The median percentage of patients in each program receivingHepatitis C testing in substance use disorder treatment : The role of program managers in adoption of testing services
AbstractD’Aunno, T., D’Aunno, T., Frimpong, J. A., Frimpong, J. A., & D'Aunno, T. (n.d.).Publication year
2016Journal title
Substance Abuse: Treatment, Prevention, and PolicyVolume
11Issue
1AbstractBackground: Health care organizations do not adopt best practices as often or quickly as they merit. This gap in the integration of best practices into routine practice remains a significant public health concern. The role of program managers in the adoption of best practices has seldom been investigated. Methods: We investigated the association between characteristics of program managers and the adoption of hepatitis C virus (HCV) testing services in opioid treatment programs (OTPs). Data came from the 2005 (n = 187) and 2011 (n = 196) National Drug Abuse Treatment System Survey (NDATSS). We used multivariate regression models to examine correlates of the adoption of HCV testing. We included covariates describing program manager characteristics, such as their race/ethnicity, education, and their sources of information about developments in the field of substance use disorder treatment. We also controlled for characteristics of OTPs and the client populations they serve. Results: Program managers were predominantly white and female. A large proportion of program managers had postgraduate education. Program managers expressed strong support for preventive services, but they reported making limited use of available sources of information about developments in the field of substance use disorder (SUD) treatment. The provision of any HCV testing (either on-site or off-site) in OTPs was positively associated with the extent to which a program manager was supportive of preventive services. Among OTPs offering any HCV testing to their clients, on-site HCV testing was more common among programs with an African American manager. It was also more common when program managers relied on a variety of information sources about developments in SUD treatment. Conclusions: Various characteristics of program managers are associated with the adoption of HCV testing in OTPs. Promoting diversity among program managers, and increasing managers' access to information about developments in SUD treatment, may help foster the adoption of best practices.Low Rates of Adoption and Implementation of Rapid HIV Testing in Substance Use Disorder Treatment Programs
AbstractFrimpong, J. A., Frimpong, J. A., D’Aunno, T., D’Aunno, T., Helleringer, S., & Metsch, L. R. (n.d.).Publication year
2016Journal title
Journal of Substance Abuse TreatmentVolume
63Page(s)
46-53AbstractIntroduction: Rapid HIV testing (RHT) greatly increases the proportion of clients who learn their test results. However, existing studies have not examined the adoption and implementation of RHT in programs treating persons with substance use disorders, one of the population groups at higher risk for HIV infection. Methods: We examined 196 opioid treatment programs (OTPs) using data from the 2011 National Drug Abuse Treatment System Survey (NDATSS). We used logistic regressions to identify client and organizational characteristics of OTPs associated with availability of on-site RHT. We then used zero-inflated negative binomial regressions to measure the association between the availability of RHT on-site and the number of clients tested for HIV. Results: Only 31.6% of OTPs offered on-site rapid HIV testing to their clients. Rapid HIV testing was more commonly available on-site in larger, publicly owned and better-staffed OTPs. On the other hand, on-site rapid HIV testing was less common in OTPs that prescribed only buprenorphine as a method of opioid dependence treatment. The availability of rapid HIV testing on-site reduced the likelihood that an OTP did not test any of its clients during the prior year. But on-site availability rapid HIV testing was not otherwise associated with an increased number of clients tested for HIV at an OTP. Conclusions: New strategies are needed to a) promote the adoption of rapid HIV testing on-site in substance use disorder treatment programs and b) encourage substance use disorder treatment providers to offer rapid HIV testing to their clients when it is available.On-site bundled rapid HIV/HCV testing in substance use disorder treatment programs : Study protocol for a hybrid design randomized controlled trial
AbstractD’Aunno, T., D’Aunno, T., Frimpong, J. A., Frimpong, J. A., D'Aunno, T., Perlman, D. C., Strauss, S. M., Mallow, A., Hernandez, D., Schackman, B. R., Feaster, D. J., & Metsch, L. R. (n.d.).Publication year
2016Journal title
TrialsVolume
17Issue
1AbstractBackground: More than 1.2 million people in the United States are living with human immunodeficiency virus (HIV), and 3.2 million are living with hepatitis C virus (HCV). An estimated 25% of persons living with HIV also have HCV. It is therefore of great public health importance to ensure the prompt diagnosis of both HIV and HCV in populations that have the highest prevalence of both infections, including individuals with substance use disorders (SUD). Methods/design: In this theory-driven, efficacy-effectiveness-implementation hybrid study, we will develop and test an on-site bundled rapid HIV/HCV testing intervention for SUD treatment programs. Its aim is to increase the receipt of HIV and HCV test results among SUD treatment patients. Using a rigorous process involving patients, providers, and program managers, we will incorporate rapid HCV testing into evidence-based HIV testing and linkage to care interventions. We will then test, in a randomized controlled trial, the extent to which this bundled rapid HIV/HCV testing approach increases receipt of HIV and HCV test results. Lastly, we will conduct formative research to understand the barriers to, and facilitators of, the adoption, implementation, and sustainability of the bundled rapid testing strategy in SUD treatment programs. Discussion: Novel approaches that effectively integrate on-site rapid HIV and rapid HCV testing are needed to address both the HIV and HCV epidemics. If feasible and efficacious, bundled rapid HIV/HCV testing may offer a scalable, potentially cost-effective approach to testing high-risk populations, such as patients of SUD treatment programs. It may ultimately lead to improved linkage to care and progress through the HIV and HCV care and treatment cascades. Trial registration: ClinicalTrials.gov: NCT02355080. (30 January 2015)Spillover effects of HIV testing policies : Changes in HIV testing guidelines and HCV testing practices in drug treatment programs in the United States
AbstractD’Aunno, T., D’Aunno, T., Frimpong, J. A., Frimpong, J. A., D'Aunno, T., Helleringer, S., & Metsch, L. R. (n.d.).Publication year
2016Journal title
BMC public healthVolume
16Issue
1AbstractBackground: To examine the extent to which state adoption of the Centers for Disease Control and Prevention (CDC) 2006 revisions to adult and adolescent HIV testing guidelines is associated with availability of other important prevention and medical services. We hypothesized that in states where the pretest counseling requirement for HIV testing was dropped from state legislation, substance use disorder treatment programs would have higher availability of HCV testing services than in states that had maintained this requirement. Methods: We analyzed a nationally representative sample of 383 opioid treatment programs from the 2005 and 2011 National Drug Abuse Treatment System Survey (NDATSS). Data were collected from program directors and clinical supervisors through telephone surveys. Multivariate logistic regression models were used to measure associations between state adoption of CDC recommended guidelines for HIV pretest counseling and availability of HCV testing services. Results: The effects of HIV testing legislative changes on HCV testing practices varied by type of opioid treatment program. In states that had removed the requirement for HIV pretest counseling, buprenorphine-only programs were more likely to offer HCV testing to their patients. The positive spillover effect of HIV pretest counseling policies, however, did not extend to methadone programs and did not translate into increased availability of on-site HCV testing in either program type. Conclusions: Our findings highlight potential positive spillover effects of HIV testing policies on HCV testing practices. They also suggest that maximizing the benefits of HIV policies may require other initiatives, including resources and programmatic efforts that support systematic integration with other services and effective implementation.
Contact
tdaunno@nyu.edu
New York, NY