INTRODUCTION
Drug Evaluation
Network System (DENS)
A project of the Treatment Research Institute
An Electronic Information System
To Track National Trends in Substance Abuse Treatment
NOTE:
Ongoing funding for the DENS project ended June 30, 2004. Although many
sites continue to send data for inclusion in our national ASI database, all
training and maintenance activities have stopped. Drs. McLellan and Carise
continue to work to secure additional funding to maintain the project
activities. There are currently over 150 substance abuse treatment sites
participating in DENS, it is expected that half will continue to regularly
provide data via modem regardless of the lack of funding.
Importantly, the Treatment Research Institute (TRI) continues to make the DENS Suite software available free of charge to any substance abuse treatment provider interested in using it. To obtain a copy of the software, please contact Mary Lou Cardell at 215-399-0980, x168, or via e-mail at mlcardell@tresearch.org.
TRI also
offers a number of training and certification options for sites with little or
no experience using the ASI or DENS Suite software. These include a
comprehensive 2-day training integrating the ASI and software, or separate 1-day
options focusing solely on either component. If you are interested in ASI
training or certification, please contact Meghan Love
at 215-399-0980 x184, or via e-mail at
mlove@tresearch.org.
The Drug Evaluation
Network System (DENS) is an 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). Although DENS is active in over 150 treatment
programs, many randomly selected, these programs do not constitute a
scientifically nationally representative sample. We continue to seek funding to
implement DENS in a nationally representative sample in order that the data
collected may be more useful to all stakeholders, additionally several states
are implementing DENS on a state-wide basis.
DENS is also being used by treatment providers in the Netherlands, Sweden,
Hungary, Ukraine, Thailand, Ireland, Scotland, Egypt, Pakistan, Lebanon, Iran,
India, and Brazil.
Why do we need standardized information systems?
Standardized Information Systems allow us to collect comparable information on the characteristics, nature, and severity of problems of the patients entering into substance abuse treatment across a geographic area. In DENS, we collect this information at the time of treatment admission. Although this is very basic information, even this type of minimal data has not been available. Consequently, policy makers at all levels have not had the information necessary to recognize important trends occurring over the past tow decades that have ultimately had profound influence on the treatment systems. These include emergence of HIV/AIDS, the cocaine and amphetamine epidemics, the influence of managed care, etc.
In the planning and administration of systems dealing with substance abuse issues, there continues to be a significant need for "real time" information about patient characteristics and the acuity of their problems. This information is essential to national and international agencies such as ONDCP, NIDA, UNODC, NIAAA, CSAT, USAID, NIJ, NIMH, the Veterans Administration, State treatment systems, and international researchers and treatment providers. To be useful, the information should be relevant to the multiple clinical, administrative, fiscal, evaluative and policy questions that so regularly arise. This information should also be available rapidly and continuously to enable observation of changes over time.
DENS provides this and a framework for a future, ongoing, treatment outcomes monitoring systems. As such, the DENS system can be utilized as a starting point for specific, locally targeted outcome studies as well as larger regional, international, or statewide outcome projects. Locally, as of June, 2004, the DENS system has been implemented in all outpatient programs in Delaware, and statewide in Louisiana and Wyoming. These states are using the ASI and software to conduct performance monitoring at the site, county, and state level. They also utilize their DENS data to evaluate the effects of substance abuse treatment on societal issues related to addiction.
How does the DENS system work?
The DENS system has
been designed around four separate principles:
1) 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 clear that the ASI by itself will not provide information on the multiple
and highly specific questions that continually arise for those in the
international, 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 limited period (e.g., 3 to 12 months), permitting answers to specific
questions in a rapid timeframe. Examples of these questions in the DENS has
included items about the use of OxyContin, “club” drugs such as Ketamine and
ecstasy; the 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.
2) Collection of
information by local staff
For economic reasons and to maximize the local utility of the information to the
treatment programs, DENS data collection is implemented by individual treatment
programs. TRI trains 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.
3) 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, during the active phase of
the DENS project data collected at the program level was transferred weekly via
modem, a process involving no significant additional work by the treatment
program staff. This resulted in the ability to analyze databases and provide
presentations and reports on patients entering treatment in all of the DENS
sites up to the prior week.
4) Representative
sampling
After successful piloting of the system, DENS began to expand into a random
national sample of treatment programs. Programs selected included 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, DENS sought to assess the patient characteristics
and problems shown by admissions to a nationally representative sample of
treatment programs to inform federal and state policy makers about current
trends in the substance abuse field. Although this was our goal, TRI has had to
end the USA national expansion activities due to lack of funding.
DENS ASI Software -
The Electronic Information Transfer Protocol
Typically, a site’s laptop 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 connect the computer modem to a telephone line and follow the
software’s prompted commands (e.g. “press send!”). The software automatically
dials and connects the computer to the DENS server. The system involves a
two-way transfer, permitting the central system at TRI to change any additional
questions as the need arises. In this way, the system has the ability to remain
current and streamlined by 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.), and is fully
HIPAA compliant. 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. . They are responsible for
the training of treatment program personnel, transfer of collected information
from the programs, 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 excited about the potential for a nationally representative DENS
system - both for the agencies that will receive the information, and for the
participating treatment programs and researchers. It should be clear that we do
not consider DENS a data collection study, but rather a system that will
hopefully continue and be sustained by its value to a variety of participants
(particularly treatment programs). Questions you may have can be directed to any
of the following project personnel toll-free (from inside the USA) at
1-877-TRI-DENS. Other callers can reach us at 1-215-399-0980.
DENS Staff
Meghan Love – Project Coordinator
Deni Carise, Ph.D. – Principal Investigator
Amy Camilleri – Quality Assurance Coordinator
Sam Rikoon – Site Coordinator
Mary Lou Cardell – ASI Helpline / Software Distribution Coordinator
A. Thomas McLellan, Ph.D. – TRI Scientific Director
Rosalyn Weinstein – TRI Project Administrator