Improving continuity of care in a public addiction treatment system with clinical case management
Improving continuity of care in a public addiction treatment system with clinical case management
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DOI：
10.1080/10550490500247099
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发表时间：
2005-10-01
影响因子：
3.7
通讯作者：
Levine, M
中科院分区：
文献类型：
--
作者：
McLellan, AT;Weinstein, RL;Levine, M
费城试图扩大成瘾治疗的可及性和连续性，重点关注每年接受多种解毒治疗（MDO）的15%的患者。五个戒毒中心的临床病例管理人员鼓励MDO患者在美沙酮、住院或门诊康复戒毒后继续接受护理，并持续改善，他们还建议为更多患者开放戒毒服务。干预前一年和干预期间三年的系统管理信息可用。每年未重复患者的计数以及治疗事件的长度和类型的测量确定了干预效果。我们检查了100例MDO患者的变更子样本记录，以评估单系统利用率。三年来，890例MDO患者接受了个案管理，并接受了评估、转诊和转移到卫生保健和清醒生活。病例管理的MDO患者的子样本显示，仅戒毒的住院人数减少了55%，康复的使用增加了70%，每次发作的平均住院时间增加了20天。虽然在评估设计中有值得注意的局限性，但研究结果与MDO患者的个案管理可能会提高公共成瘾治疗的临床适当性和行政效率的观点一致。
Philadelphia attempted to expand the access to and continuity of addiction treatment by focusing on the 15% of patients who received multiple, detoxification-only (MDO) treatments each year. Clinical Case Managers at five detoxification centers encouraged MDO patients to continue care following detoxification in methadone, residential, or outpatient rehabilitation, and sustain improvements, and they recommended opening detoxificafion access for additional patients as well. System administrative information was available for one year prior and three years during the intervention. Counts of unduplicated patients within each year and measures of the length and type of treatment episodes determined the intervention effects. Records from a changes sub-sample of 100 MDO patients were examined to assess sin gstem utilization. Over three years, 890 MDO patients were case managed and bad received assessment, referral, and transort to health care and sober living. The sub-sample of case-managed MDO patients showed a 55% reduction in detoxification-only admissions, a 70% increase in use of rehabilitation, and a twenty-day increase in the average length of stay per episode. Though there are noted limitations in the evaluation design, the findings are consistent with the view that individual case management of MDO patients may improve the clinical appropriateness and administrative efficiency of public addiction treatment.