Performance contracting to engage detoxification-only patients into continued rehabilitation
Performance contracting to engage detoxification-only patients into continued rehabilitation
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DOI：
10.1016/j.jsat.2010.09.001
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发表时间：
2011-03-01
影响因子：
3.9
通讯作者：
Lynch, Kevin G.
中科院分区：
文献类型：
--
作者：
Haley, Sean J.;Dugosh, Karen Leggett;Lynch, Kevin G.
2006年，特拉华州戒毒患者中只有18.7%在出院后30天内继续接受康复治疗。作为回应，特拉华州建立了财政应急计划，以(1)保持90%的戒毒使用率，(2)根据25%的患者进入治疗，每月收取10%的设施报销，(3)为每位接受过三次或以上戒毒治疗的患者提供500美元的奖金。根据履行合同，戒毒提供者(1)保持了90%的入住率要求，(2)在12个月中有7个月达到了25%的治疗进入目标，(3)只有8%（27/337）的戒毒完成了目标停留时间。对于有三次或更多先前解毒的患者，继续和保留治疗甚至受到更大的限制。与政策意图相反，2008财政年度（FY）戒毒三次或更多的患者数量几乎是2006财政年度的三倍。在没有改变患者可及性的情况下，实现了过渡率的适度增加；2008财政年度患者报告的无家可归率明显高于2006财政年度执行合同之前，首次使用的年龄也更年轻。绩效合同可能为改善向治疗率的过渡提供了希望。但是，戒毒患者的独特需求、各级护理满足患者需求的治疗能力以及履行合同的结构都必须仔细考虑。当整个系统的服务契约紧密同步时，性能契约的工作可能会得到加强。(C) 2011爱思唯尔公司版权所有。
In 2006, only 18.7% of Delaware's detoxification patients were admitted to continuing recovery-oriented treatment within 30 days after discharge. In response, Delaware established financial contingencies to (1) maintain 90% detoxification occupancy, (2) make receipt of 10% of the facility's monthly reimbursement contingent on 25% of patients entering treatment, and (3) provide a $500 bonus for every patient with three or more prior detoxification visits who was retained in treatment. Under the performance contract, the detoxification provider (1) maintained the 90% occupancy requirement, (2) achieved the 25% treatment entry target for 7 of 12 months, and (3) observed only 8% (27/337) of detoxification completions that met the targeted length of stay. Continuation to and retention in treatment was even more constrained for patients with three or more prior detoxifications. Contrary to the policy intent, the number of patients with three or more detoxifications in fiscal year (FY) 2008 is nearly triple that of FY 2006. The modest gain in the transition rate was achieved without changes in patient access; the FY 2008 patient population reported significantly higher rates of homelessness and a younger age of first use than before the performance contract in FY 2006. Performance contracting may offer promise for improving transition to treatment rates. However, the unique needs of detoxification patients, the treatment capacity of each level of care to meet patient needs, and the structure of the performance contract must be carefully considered. Performance contracting efforts may be strengthened when service contracts across the system are tightly synchronized. (C) 2011 Elsevier Inc. All rights reserved.