| Health information technology has the capacity to facilitate work processes and practices while improving clinical outcomes. A highly functional health IT system can provide real-time data sharing for clinicians to coordinate services efficiently and may help clients to be more engaged in their health care. Despite health IT's potential benefits, there is limited research on its adoption in adult outpatient substance use treatment, particularly its added value to the effects of retention strategies, such as flexible scheduling and co-location, on client engagement and length of stay in treatment. Even though treatment engagement and retention are not clinical outcomes, they are associated with reduced substance use, treatment completion, and crifminal justice involvement outcomes. This underscores the importance of examining the effectiveness of retention strategies and if health IT can enhance them to improve treatment engagement and retention. Such investigation would be even more beneficial to programs serving a high proportion of clients with co-occurring mental and substance use disorders, as this subpopulation encounters greater engagement and retention challenges.;Using administrative and client service encounter data from Washington state, the study 1) explored structural and contextual factors associated with health IT adoption in adult outpatient substance use treatment programs and 2) investigated if health IT adoption and retention strategies, together or alone, are significantly related to client engagement and 90-day retention in treatment programs. Resource dependence theory, diffusion of innovation theory, and Andersen's behavioral model of health services utilization guided the study's conceptual framework, hypotheses, and analysis.;The study consisted of two sequential phases. In phase I, the study adopted a multi-level, cross-sectional design to account for individual program effects on client performance in substance use treatment. Analytic methods included negative binomial and random effects, logistic regressions to explore factors associated with health IT adoption and the relationships between health IT adoption, retention strategies, and treatment engagement and 90-day retention. Phase II included qualitative, semi-structured phone interviews with health IT informants from seven outpatient treatment programs to contextualize the quantitative findings from phase I.;Regression results from phase I revealed that CARF accreditation was a significant determinant of health IT adoption. However, health IT adoption, transportation assistance, flexible scheduling, and co-location, together or alone, were not significantly associated with client engagement or 90-day retention. Ninety-day retention was slightly better for clients with co-occurring mental and substance use disorders if they were in programs with greater health IT adoption.;Data from the qualitative interviews suggest that treatment programs' health IT systems may be lacking essential functionalities that could support the critical enabling factors of treatment engagement. Yet, additional research is necessary to explore whether more advanced health IT systems can impact treatment performance. The study findings may encourage program directors to assess the electronic functions imperative in a behavioral health IT system that can support care delivery and client treatment performance. Treatment programs may also be motivated to reassess the effectiveness of their client retention strategies and evaluate ways that the strategies may be strengthened to have an impact on treatment engagement and retention. |
