MEDICAL VS SOCIAL MODEL DAY TRERTMENT--OUTCOME AND COST

申请人摘要]：随着越来越多的人接受治疗 对于酒精依赖和滥用，医疗保健成本控制的时代 挑战了传统住院治疗的成本效益。 临床研究表明，门诊治疗酗酒和 依赖性可能与住院治疗和日间医院一样有效 医疗模式程序已经成为一种突出的门诊模式。 然而，医学模式课程通常比 非临床方向，如社会模式的方法，虽然 医疗模式与社会模式日间治疗效果和费用， 被评估。 考虑到常见问题的范围和严重性， 在酒精治疗的客户中，一个问题仍然是什么是最佳的 康复方法，以及这是否因性别、种族、 和精神科合并症 这项研究进行了一个对照，随机 两种日间治疗方法的分配比较--医学模式 和社会模式--在“真实的世界”中， 人群（N=300; 28%为女性，33%为非洲裔美国人，33%为西班牙裔） 反映了许多城市社区的个人寻求帮助， 喝酒 使用意向治疗模型，该研究比较了 日间医学模式治疗和日间社会模式治疗 所提供的照顾。 它调查了在采取不同的方法， 两个项目的药物滥用治疗，包括数量和 预定活动的内容和获得的服务，工作人员的作用， 以及由相应取向所强调的区域。 它比较 治疗后结果和戒断方面的改善率， 酒精消费和药物使用，医疗和精神病水平 就业水平、法律的和家庭/社会问题，以及 社交网络对禁欲的积极性，并认为 利用相应的卫生和社会服务。 该研究旨在 确定与成功治疗相关的患者特征 每个项目方向的结果，以及相关治疗方面 在治疗后6个月和12个月有改善。 最后，比较 日间医疗模式和日间社会模式治疗的成本，并评估 两个方案的相对成本和效益。

APPLICANT'S ABSTRACT]: As increasing numbers of individuals enter treatment for alcohol dependence and abuse, an era of cost containment in health care challenges the cost effectiveness of traditional inpatient treatment. Clinical studies suggest that outpatient treatment for alcohol abuse and dependence may be as effective as inpatient treatment, and day hospital medical model programs have become a prominent outpatient modality. However, medical model programs are in general more expensive than non-clinical orientations such as the social model approach, although the effectiveness and cost of medical versus social model day treatment have not been assessed. Given the range and severity of problems commonly found among alcohol treatment clients, a question remains of what is the optimum approach for rehabilitation and whether this differs by gender, ethnicity, and psychiatric comorbidity. This study undertakes a controlled, random assignment comparison of two approaches to day treatment--the medical model and the social model--in "real world" agencies serving a heterogenous population (N=300; 28% women, 33% African American, and 33% Hispanic) reflective of many urban communities of individuals seeking help for their drinking. Using an intent to treat model, the study compares the effects of day medical model treatment and day social model treatment during the course of the care provided. It investigates differences in the approach taken to substance abuse treatment at the two programs, including the number and content of scheduled activities and services received, the role of staff, and areas stressed by the respective orientations. It compares post-treatment outcome and improvement rates in the areas of abstinence and alcohol consumption and drug use, levels of medical and psychiatric problems, levels of employment, legal and family/social problems, and supportiveness of social networks towards abstinence, and considers utilization of corresponding health and social services. The study aims to identify patient characteristics associated with successful treatment outcomes in each program orientation, and aspects of treatment associated with improvement at six and 12 months post-treatment. Finally, it compares the costs of day medical model and day social model treatment, and assesses relative cost and effectiveness of the two programs.