TOP bulletin Changes to the Treatment Outcomes Profile reporting

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					  TOP bulletin Changes to the
  Treatment Outcomes Profile
  reporting frequency       e s Pr
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  July 2009
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  Gateway number: 12250
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Changes to the TOP reporting frequency

What is changing?
The National Treatment Agency for Substance Misuse (NTA) has reduced the frequency
that clinicians and keyworkers need to submit Treatment Outcomes Profile (TOP) data.

TOP works at three different stages:
1 The start of a client’s treatment journey – Treatment Start TOP
2 Periodically throughout the client’s treatment journey – Review TOP
3 When the client leaves the treatment system – Treatment Exit TOP

The change comes at the Review TOP stage, during the client’s treatment journey.
Previously, the protocol asked for the Review TOP to be reported in 12-week cycles –
typically as part of the care-plan review cycle. But following consultation with the field,
the NTA has agreed that the Review TOP can now be reported less often.

This will not compromise the ability of TOP to capture information about the important
treatment benefits that occur early in the treatment journey, or affect how often the
TOP is completed as part of the care-plan review cycle.

The revised protocol now asks that clinicians and keyworkers report the Review TOP in
26-week or six-month cycles.

The new protocol for TOP reporting

      Treatment Start          1st Review TOP            2nd Review TOP             3rd Review TOP                   Review TOPs
     TOP required +/-          anchored to the           anchored to the            anchored to the                   continue in
    two weeks of the         modality start date,      modality start date,        modality start date,         26-week cycles until
    modality start date       and completed at          and completed at         and completed at any            the client exits the
                             any time during the       any time during the       time during the 53-78            treatment system
                              5-26 week period         27-52 week period             week period

 – two    of first   + two    1st Review: 5-26 weeks   2nd Review: 27-52 weeks    3rd Review: 53-78 weeks         Continue review cycle
 weeks   modality    weeks

                                                                                                Exit TOP, -/+
                                                                                               two weeks of
                                                                                               discharge date

Why is it changing?
The NTA established a compliance threshold of 80% for the three TOP reporting stages.
This is the completion rate providers and partnerships have to achieve for each of the
three stages before any data can be released to local treatment systems. The aim of the
threshold is to avoid issues such as sample bias, and to ensure that local treatment
systems can use and interpret the data with confidence.

National compliance for the Treatment Start TOP is approaching 80%, with 76% of
new clients receiving a TOP. In addition, 56% of clients are getting a Treatment Exit TOP.
However, compliance for the Review TOP is patchy, averaging just 38%.

The NTA has been concerned that progress towards the compliance threshold has been
slow. As a result, we have undertaken further consultation including visiting

                                                                                               Changes to the TOP
                                                                                               reporting frequency

partnerships and providers to improve our understanding of the issues that are
hindering progress.

In light of this research, we examined the potential impact of changing the reporting
frequency and consequently decided that we could reduce it without compromising the
opportunity to capture vital information on the treatment journey.

How will the change work?
Keyworkers and clinicians who submit Review TOPs on the new 26-week or six-month
cycle need do nothing more.

Those who submit them on the 12-week cycle may continue to do so – the NTA will
make the necessary adjustments at the data analysis stage. In these cases, we will select
the Review TOP with the latest date in the context of the new 26-week cycle, as that
gives us the most up-to-date information on the client’s status. For example, if the first
Review TOP was completed at week five and the second at week 24, the latter TOP will
go forward for analysis.

This doesn’t mean the other Review TOPs completed as part of a 12-week cycle will go
to waste. In fact, they remain valuable sources of information and will be used in other
outcomes analysis.

Software prompts
TOP software suppliers have introduced a reporting function (part of Core Data Set F)
that helps providers identify when a Review TOP is due, based on the 12-week cycle.
The NTA will soon notify all suppliers of the protocol changes, asking them to amend
the reporting function to work on the new 26-week cycle.

Despite the change, the former 12-week TOP cycle remains consistent with the care
planning cycle. It is good practice to regularly review clients and the TOP is a useful tool
in helping to develop and monitor care plans. Local treatment providers can decide
whether they wish to continue with a quarterly administration of TOP for clinical review
purposes. However, the NTA will request a Review TOP only within each six-month
period from now on.

Treatment stages
TOP is the first attempt anywhere in the world to introduce a routine national outcome
monitoring system for drug treatment. As such, new information on how it works in
practice is coming to light all the time.

An example is the discovery that frequent mismatches occur between the TOP-reported
treatment stage and the date where the TOP is administered within the client’s
treatment journey. For instance, a TOP administered within two weeks of a client
starting a new treatment journey might be recorded as a Planned Exit TOP.

In many cases the cause is a key-stroke error. Alternatively, it involves a client moving
from one agency to another, leading to a breakdown in the TOP-reporting sequence.

To avoid this, the new 26-week protocol will match the TOP to the treatment stage
recorded in National Drug Treatment Monitoring System (NDTMS) data. The NTA will
also generate exception reports relating to mismatches between TOP treatment data
and NDTMS start and end dates.                                                                                                3
                                                                                                       Changes to the TOP
                                                                                                       reporting frequency

What difference will the change make?
It means clinicians and keyworkers need to complete the TOP with clients less often,
reducing any unnecessary burden they may have experienced.

Furthermore, the change will help partnerships and providers reach the 80% compliance
threshold as the number of Review TOPs completed increases as a result of the wider
reporting window. This in turn means a more timely and complete release of data to local
treatment systems.

It is important to note that the reduced frequency of TOP reporting to NDTMS does not
affect how often TOP can be completed as part of the care planning review cycle – so local
partnerships can receive robust outcomes data for their treatment systems more quickly,
without it compromising the role TOP plays in the care planning.

 TOP: five key messages
 An important outcome from the NTA’s consultations with a number of partnerships and
 providers has been the development of five key messages that everybody involved with
 completing and reporting TOP should be familiar with.

                          All staff responsible for completing TOPs
                             need to be aware of the following:

           The NTA designed the TOP in partnership with the field. The TOP provides clients and
    1      clinicians with an additional way of seeing whether their current care plan is working,
           and commissioners with more suitable information to assess the impact of treatment.

           You should complete TOPs at the start of a client’s time in treatment, then around
    2      every 26 weeks as part of the care plan review process, and finally when the client
           exits treatment.

           When completing a TOP, remember that ‘NA’ means ‘not answered’. Use NA when the
    3      client cannot remember a particular detail or refuses to disclose information relating to
           any or all of the items in the TOP.

           Section 1 of the TOP should report all illicit drug use. This includes methadone and
    4      buprenorphine (subutex) that the client has obtained on the street rather than by
           prescription – record these in the opiates section.

           Information we collect about clients via the TOP is subject to the same confidentiality
    5      safeguards as all other drug treatment and health data. It is important that clients feel
           reassured of this fact, as it will encourage them to report their behaviour accurately.

                   NTA, 6th Floor, Skipton House, 80 London Road, London SE1 6LH
4                T: 020 7972 1999 F: 020 7972 1997 E:

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Description: TOP bulletin Changes to the Treatment Outcomes Profile reporting