COST EFFECTIVENESS OF DUAL DIAGNOSIS TREATMENT

这项提案寻求在正在进行的两项研究中增加成本部分 双重诊断为重症患者的治疗方法 精神疾病和药物使用障碍。该研究比较了 使用计划的传统社区支持计划(CSP)案例管理 将药物滥用和精神障碍的治疗结合在一起 一种自信的病例管理方法，我们称之为持续治疗小组 (CTT)。大约230个客户端将随机分配给任一CSP 或CTT，并在三年内跟踪评估相对的 这两种方法的有效性。因为相关的困难 与严重的精神疾病和药物使用障碍并存，这些 客户被认为是特别高的资源用户。的一个目标 拟议的研究是为了收集关于资源的准确的客户级数据 使用。 通过将多个时间点的资源使用数据与 已经作为一部分收集的关于有效性的大量数据 在最初的研究中，我们将能够比较成本效益 随着时间的推移，两种方法中的一种。我们假设总的资源使用量 CTT客户的成本将随着时间的推移而减少，即使最初的投资 每名患者可能大于CSP方法，而CTT 在三年的后续行动中将比CSP更具成本效益 句号。定期衡量资源使用情况和效率 允许我们通过跟踪以下内容的变化来测试这些假设 随时间推移的成本效益。 社区和家庭负担问题变得更加重要，因为 重症精神病患者住院时间更短，住院时间更长 在家里或在社区里。之前的心理健康成本研究使用 估算社区和家庭成本的间接方法，对其进行测量 不完全的，或者根本没有测量到它们。在这项研究中，我们将 改进记录社区和家庭使用情况的现有技术 资源。我们将利用新开发的客户和家庭访谈来 更准确地计算这些成本。我们假设CTT的客户会 使用的家庭和社区资源比CSP客户端少 随访期。

This proposal seeks to add a cost component to an ongoing study of two approaches to treatment of people who are, dually diagnosed with severe mental illness and substance use disorders. The study compares traditional Community Support Program (CSP) case management with a program that integrates treatment for substance abuse and psychiatric disorders in an assertive case management approach we call Continuous Treatment Teams (CTT). Approximately 230 clients will be randomly assigned to either CSP or CTT and followed over a three-year period to evaluate the relative effectiveness of the two approaches. Because of difficulties associated with co-occurring severe mental illness and substance use disorders, these clients are believed to be particularly high resource users. One goal of the proposed study is to collect accurate client-level data on resource use. By combining data on resource use at several points in time with the extensive data on effectiveness that are already being collected as a part of the original study, we will be able to compare the cost-effectiveness of the two approaches over time. We hypothesize that total resource use by CTT clients will decrease over time, even though the initial investment per patient may be greater than that of the CSP approach, and that CTT will be more cost-effective than CSP within the three-year follow-up period. Measuring resource use and effectiveness at regular intervals allows us to test these hypotheses by tracking changes in cost-effectiveness over time. Questions of community and family burden have become more important as severely mental ill patients spend less time in hospitals and more time at home or in the community. Previous mental health cost studies used indirect methods for estimating community and family costs, measured them incompletely, or failed to measure them at all. In this study we will improve on existing techniques for documenting use of community and family resources. We will use newly developed client and family interviews to capture these costs more accurately. We hypothesize that CTT clients will use fewer family and community resources than CSP clients during the follow-up period.