Introduction
Drug Evaluation Network System (DENS):
An Electronic Information System to Track National Trends in Substance Abuse Treatment
The Drug Evaluation Network System (DENS) is a national, electronic, treatment-tracking project. The goal of the project is to provide practical and current clinical and administrative information on patients entering into substance abuse treatment throughout the nation. Ultimately this system will include alcohol and drug treatment programs representatively sampled from all areas of the country. The system will include programs from the different treatment modalities (non-hospital residential, outpatient, abstinence-oriented, methadone maintenance, and drug courts) and facility types (public, private, and Veterans Medical Affairs Centers).
DENS is a a collaboration evaluation effort between The Treatment Research Institute (TRI) at the University of Pennsylvania (A. Thomas McLellan, Ph.D. and Deni Carise, Ph.D.) and The National Center on Addiction and Substance Abuse (CASA) at Columbia University (Herbert D. Kleber M.D. and Joseph A. Califano Jr., J.D.). DENS is sponsored by The White House Office of National Drug Control Policy (ONDCP) and The Center For Substance Abuse Treatment (CSAT).
Why do we need a national information system?
Until the formation of the DENS pilot sites, there was no system of data collection in the country focused upon the characteristics, nature and severity of problems of the patients entering into substance abuse treatment across the country. In DENS, we are collecting this information at the time of treatment admission. Although this is very basic information, even this type of minimal data has not been available since the 1970s. Consequently, policy makers at the federal and state levels have not had the information necessary to recognize important trends occurring over the past two decades - trends that have ultimately had profound influence on the treatment system such as the emergence of AIDS, the cocaine and amphetamine epidemics, the influence of managed care, etc.
There continues to be a significant need for “real time” information about patient characteristics and the acuity of their problems in the planning and administration of systems that deal with substance abuse problems. This information is essential to national agencies such as ONDCP, NIDA, NIAAA, CSAT, CSAP, NIJ, NIMH, the Veterans Administration, and to State treatment systems. To be useful, the information should be relevant to the multiple clinical, administrative, fiscal, evaluative, and policy questions that so regularly arise; and the information should be available rapidly and continuously to enable observation of changes over time.
DENS provides this and a framework for a future, ongoing, nationwide treatment outcomes monitoring system. As such, the DENS system can be utilized as a starting point for specific, targeted outcome studies, or for large, regional, or statewide outcome projects.
How does the DENS system work?
The DENS system has been designed around four separate principles:
1) Nationally representative sampling
After successful piloting of the system, DENS has begun to expand into a random national sample of treatment programs. Programs selected include publicly and privately funded programs from all areas of the country and all major treatment modalities. Just as television advertisers have developed the nationally representative set of "Nielsen Families" whose daily habits inform us about the trends in television watching, the patient characteristics and problems shown by admissions to the nationally representative sample of treatment programs will inform federal and state policy makers about current trends in the substance abuse field.
2) Reliable, valid and flexible information on relevant patient characteristics
The Addiction Severity Index (ASI) is the primary source of patient information. The ASI provides basic, valid clinical and administrative information on patients entering the national treatment system. The ASI is a free, public domain instrument, and is the most widely used instrument in the substance abuse field. Information from the ASI is useful to the clinical staff in the initial assessment of patients and to administrative staff in providing the information so often needed for reporting purposes. The ASI also provides baseline information that will ultimately be used in outcome evaluation efforts.
It is also clear that the ASI by itself will not provide information on the multiple and highly specific questions that continually arise for those in the national and state policy arena (e.g., How many pregnant women are in the system? How many patients are referred directly from jail? How many women have children to care for?) To address areas of interest as they come up, we have provided for the addition of up to 40 questions that may be included for a time-limited period (e.g., 3 to 12 months), permitting answers to specific questions in a rapid timeframe. Examples of these time limited questions in the DENS pilot included questions about the use of “club” drugs such as Ketamine and ecstasy; effects on substance use and mood following the World Trade Center destruction; and on involvement in treatment as a direct result of the criminal justice system.
3) Collection of information by local staff
For economic reasons, and to maximize the local utility of the information to the treatment programs, the data collection is implemented by individual treatment programs. We train staff members to administer the ASI on a laptop computer, and to use the data transfer system (described below). We provide new visually oriented software that identifies areas for clinical care planning, assists with accurate data collection, and provides clinical narrative reports.
4) Rapid Transfer of Data on a Timely Basis to a Central Information System
The true value of this information to the national substance abuse treatment and policy development effort is the availability of "real time" information on patients entering the treatment system. To this end, the data collected at the program level is transferred weekly via high-speed modem, and does not involve significant additional work by the treatment program staff.
DENS ASI Software - The Electronic Information Transfer Protocol
The computer includes an internal modem and a built-in protocol for the easy transfer of ASI data. Information is downloaded to the DENS (SQL-Server) workstation in Philadelphia, where data from across the nation are received and stored. Transferring data via modem is an easy process; program staff simply connects the computer modem to a telephone line and follow the software’s prompted commands (“press send!”). The software automatically dials and connects the computer to the DENS computing station. The system involves a two-way transfer, permitting the central system to change additional questions as the need arises. In this way, the system will continue to be current, and streamlined, asking a few targeted questions of administrative and clinical significance, getting the answers rapidly and then discontinuing those questions in favor of other questions that will inevitably arise.
The system is specifically designed not to transfer any identifying information (i.e., name, social security number, phone number, address, etc.). Data are stored in electronic folders dedicated to each agency and merged together to produce a national DENS database.
Administration, Access, and Patient Protection
The DENS information system is a public domain system, implemented and operated by researchers at the Treatment Research Institute at the University of Pennsylvania. They are responsible for the continued training of the treatment program personnel, the transfer of collected information from the programs, and the maintenance and security of the information database (again - no identifying information on patients/clients are sent via modem to TRI). This information/data will never be marketed or sold. Clinical, research and administrative information will be available for use by researchers, clinical personnel, and of course, policy makers.
Summary
We at TRI are very excited about the possibilities of such a system - both for the national agencies that will receive the information, and for the participating treatment programs and researchers. It should be clear that we do not consider this a data collection study, but rather a continuing project that will be sustained by its value to a variety of participants, particularly the treatment programs. Questions you may have can be directed to any of the following project personnel toll-free at 1-877-TRI-DENS
DENS Staff
Rosalyn Weinstein – TRI Project Administrator
A. Thomas McLellan, Ph.D. – TRI Scientific Director
Deni Carise, Ph.D. – DENS Principal Investigator
Meghan Love – DENS Project Coordinator
Kathy Geary – DENS Project Coordinator
Amy Camilleri – DENS Quality Assurance Coordinator
Miriam Ackerman – DENS Site Coordinator/Research Assistant
Michelle Boss – DENS Site Coordinator/Research Assistant