Program- and service-level costs of seven screening, brief intervention, and referral to treatment programs
Program- and service-level costs of seven screening, brief intervention, and referral to treatment programs
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DOI：
10.2147/sar.s62127
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发表时间：
2014-01-01
影响因子：
1.8
通讯作者：
Vendetti, Janice
中科院分区：
文献类型：
--
作者：
Bray, Jeremy W.;Mallonee, Erin;Vendetti, Janice
本文探讨了美国药物滥用和心理健康服务管理局资助的前七个示范项目中提供筛查、简短干预和转诊治疗 (SBIRT) 服务的成本。对实施模式（签约专科医生、内部专科医生、内部全科医生）和服务提供环境（急诊科、医院住院病人、门诊病人）的服务水平成本进行了估计和比较。对受资助者计划之间的计划级成本进行了估计和比较。服务水平数据是通过对 SBIRT 服务交付的定时观察来收集的。项目级数据是使用结构化成本访谈指南在关键知情人访谈期间收集的。在服务层面，患者参与之前或之后发生的支持活动占提供 SBIRT 服务（尤其是短期服务）成本的很大一部分。在项目层面，随着更多患者接受筛查，平均成本下降。比较不同的计划和服务级别，在计划级别计算的平均年度运营成本通常超过实际服务交付的成本。在某些情况下，由于与计划运营相关的潜在大量固定和准固定成本，提供者用于支持服务提供的时间可能占成本的很大一部分。筛查、短暂干预和转诊治疗的成本结构复杂且患者流程不连续，导致年度运营成本超过某些环境和实施模式的实际服务提供成本。
This paper examines the costs of delivering screening, brief intervention, and referral to treatment (SBIRT) services within the first seven demonstration programs funded by the US Substance Abuse and Mental Health Services Administration. Service-level costs were estimated and compared across implementation model (contracted specialist, inhouse specialist, inhouse generalist) and service delivery setting (emergency department, hospital inpatient, outpatient). Program-level costs were estimated and compared across grantee recipient programs. Servicelevel data were collected through timed observations of SBIRT service delivery. Program-level data were collected during key informant interviews using structured cost interview guides. At the service level, support activities that occur before or after engaging the patient comprise a considerable portion of the cost of delivering SBIRT services, especially short duration services. At the program level, average costs decreased as more patients were screened. Comparing across program and service levels, the average annual operating costs calculated at the program level often exceeded the cost of actual service delivery. Provider time spent in support of service provision may comprise a large share of the costs in some cases because of potentially substantial fixed and quasifixed costs associated with program operation. The cost structure of screening, brief intervention, and referral to treatment is complex and discontinuous of patient flow, causing annual operating costs to exceed the costs of actual service provision for some settings and implementation models.