Linkages Between Patient-centered Medical Homes and Addiction Treatment Organizations: Results From a National Survey.
Linkages Between Patient-centered Medical Homes and Addiction Treatment Organizations: Results From a National Survey.
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DOI：
10.1097/mlr.0000000000000645
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发表时间：
2017-04
期刊：
影响因子：
3
通讯作者：
Friedmann PD
中科院分区：
文献类型：
--
作者：
D'Aunno T;Pollack H;Chen Q;Friedmann PD
为了实现提供全面和协调护理的目标，以患者为中心的医疗之家 (PCMH) 需要协调为患有药物滥用障碍的个人提供的服务。然而，美国各地每天为超过 100 万人提供服务的 14,000 个成瘾治疗 (AT) 组织通常没有做好与 PCMH 合作的准备（例如，AT 组织通常缺乏电子健康记录）。检查成瘾治疗（AT）组织通过合同与 PCMH 建立正式联系的程度；确定 PCMH 和 AT 组织之间联系的关键方面（例如，电子健康记录的共享使用）；识别 AT 组织的特征及其与这些联系相关的环境。我们借鉴了 2014 年对 695 个 AT 组织的主任和临床主管进行的全国代表性调查（n=1,390 名调查受访者）的数据。全国 38% 的患者正在与 PCMH 签订合同的 AT 组织接受治疗。在扩大医疗补助计划的州，这一数字增加到 51%（而在未扩大医疗补助计划的州，这一数字仅为 6.2%）。然而，绝大多数联系都相对较弱；它们不包括患者信息的交换。多变量分析的结果表明，规模较大的非营利性公有 AT 组织，以及位于东北部和扩大医疗补助覆盖范围的州的 AT 组织更有可能与 PCMH 签订合同。如果 AT 组织和 PCMH 之间没有更紧密的联系，或者没有开发其他整合服务的模型，患有 SUD 的个人可能会继续接受不协调的护理。
To meet their aims of providing comprehensive and coordinated care, patient-centered medical homes (PCMHs) need to coordinate services for individuals with substance use disorders. Yet, the 14,000 addiction treatment (AT) organizations across the U.S. that provide services for more than 1 million individuals daily are generally ill-prepared to work with PCMHs (e.g., AT organizations often lack electronic health records). To examine the extent to which addiction treatment (AT) organizations have formal linkages through contracts with PCMHs; to identify key dimensions of linkages between PCMHs and AT organizations (e.g., shared use of electronic health records); to identify characteristics of AT organizations and their environments associated with these linkages. We draw on data from a 2014 nationally-representative survey of directors and clinical supervisors from 695 AT organizations (n=1,390 survey respondents). 38% of patients across the nation are receiving treatment in AT organizations linked by contracts to PCMHs. This number increases to 51% in states that expanded Medicaid (vs. only 6.2% of patients in non-Medicaid expansion states). Yet, the great majority of linkages are relatively weak; they do not include the exchange of patient information. Results from multivariable analyses show that larger, non-profit and publicly-owned AT organizations, as well as those located in the northeast and in states that expanded Medicaid coverage, are more likely to have contracts with PCMHs. Without stronger linkages between AT organizations and PCMHs or the development of other models that integrate services, individuals with SUDs may continue to receive uncoordinated care.