AEGIS Medical Systems, Inc. - Increasing Continuation in Opioid Treatment

Aegis Medical Systems, Inc., operates 25 opioid treatment program (OTP) clinics in 15 counties throughout the state of California. With headquarters in Los Angeles, Aegis Medical Systems provides services to more than 5,000 patients a day.

The Director of Clinical Services, Arron Hightower, was concerned that Aegis sites were losing patients within the first 90 days of treatment.

An analysis of 17 months of admission and discharge data for all 25 Aegis locations, captured by its electronic record system, showed that:

• Women were 5% more likely than men to discharge in the first 90 days
• Patients paying out-of-pocket were more likely to discharge early that those covered by Drug MediCAL (California’s Medicaid) at a rate of 3:1
• Patients age 27 and older were more likely to discharge than 18- to 26-year-olds
• Patient discharges were most likely to occur in multiples of seven days
• The greatest number of patients left in the first five days of treatment: 8.54%

• Increase continuation in treatment

The change team set a goal to reduce attrition among patients in the first 90 days of treatment by 10% over a six-month period.

Based on the analysis of discharge data, the team decided to concentrate solely on the first five days of treatment. The test site for this change project was the Aegis clinic in Simi Valley, which serves about 200 patients daily.

Before the change project, the patient’s first appointment could take up to four hours. It included admissions paperwork and a medical assessment, with the first clinical intervention scheduled from one week to three weeks later. Many clients never returned for the clinical appointment after the lengthy admissions process.

The first change the team tested was the “Five in Five” strategy. Patients were required to come to the clinic once daily for five days to complete the admission process.

On Day 1, the patient would have a medical assessment. On Days 2–5, the patient met with a counselor/clinician to tell his or her story. This allowed the clinician time to complete the required documentation while establishing a therapeutic relationship with the client.

• Attrition rates fell from 16% to 4%
• Projected increase in annual revenue from reduced attrition rates: $388,000

Figure 1

• Analyzing discharge data helped the team identify the most crucial timeframes for attrition.
• Engaging patients in the first five days gave them the clinical and medical interventions they needed and stabilzed patient census.
• One of the biggest challenges for opioid treatment programs is meeting regulatory requirements. In the past, the Aegis admission process focused more on those requirements than on engaging the patient. This change project shifted the focus to patients’ clinical and medical needs, while allowing staff to complete mandatory documentation in the required timeframe.

• Add an eight-week group following the first five days of treatment to increase retention and delay the first day of attrition
• Following the eight-week test period, implement the “Five in Five” program design to all 24 AEGIS sites throughout California