COST EFFECTIVENESS OF DUAL DIAGNOSIS TREATMENT

这项建议旨在为正在进行的两项研究增加一个费用部分， 治疗双重诊断为严重 精神疾病和物质使用障碍 该研究比较 传统的社区支持计划（CSP）案例管理， 它将药物滥用和精神疾病的治疗整合在一起， 我们称之为持续治疗团队的自信病例管理方法 （CTT）。 大约230名客户将被随机分配到 或CTT，并随访三年，以评估相对 两种方法的有效性。 由于相关的困难 同时发生的严重精神疾病和物质使用障碍，这些 客户被认为是特别高的资源使用者。的一个目标 拟议研究是收集关于资源的准确的客户一级数据 使用. 通过将几个时间点的资源使用数据与 已经收集了大量关于有效性的数据， 我们将能够比较成本效益， 这两种方法随着时间的推移 我们假设总的资源使用 CTT的客户将随着时间的推移而减少，即使最初的投资 每例患者的CTT可能大于CSP方法， 在3年随访期内， 期 定期衡量资源使用情况和有效性 让我们可以通过追踪 成本效益随着时间的推移。 社区和家庭负担问题变得更加重要， 严重精神病患者在医院的时间更少， 在家里或社区。 以前的心理健康成本研究使用 估计社区和家庭成本的间接方法， 不完全地，或者根本没有测量它们。 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 我们将使用新开发的客户和家庭访谈， 更准确地计算这些成本。 我们假设CTT客户将 与CSP客户相比， 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.