A MULTISITE MATCHING OF TREATMENT FOCUS TO DYSFUNCTION

最近的研究已经开始支持这样的假设，即通过匹配 根据患者资料进行治疗，可以提高治疗效果 需要对这一概念进行阐述，治疗的哪些方面 积极加强对结果的哪些方面的影响 什么类型的病人？考虑到“匹配效应”的事实，它变得均匀 更重要的是测试这些影响的普遍性。会吗？ 是否发生匹配，而与治疗方案和设置无关？做 配对效果同样适用于预后较差和预后较好的患者 相似吗？配对效应能否在患者群体中观察到 自愿参加随机临床试验？ 这项拟议的研究检验了两种治疗方法的重点 当模式与主要模式匹配时，将改善患者的结果 功能障碍的区域。以心理症状为主要特征的患者 当功能障碍与个人专注的 认知行为疗法；以功能障碍为主的患者 社会将从社区强化方法中获得更多好处 治疗。这些假设在三个治疗水平上进行了测试 环境--住院病人。部分医院和门诊。匹配效果包括 为临床分配的预后良好和预后差的患者检查 患者以及同意随机分配的患者。不同 提供者组织作为绩效站点参与：HMO、 综合医院和一家专门从事化学品治疗的社区医院 依赖和上瘾。 为了检查治疗增强中涉及的有效成分， 收集和分析了理论上有重点的治疗措施 与它们对相关患者特征的影响有关。 对患者进行两年的随访，并测量结果。 多维方式。预计结果将产生影响 在日常的临床设置上，也预计 临床研究中心与临床绩效之间的协作 网站可以作为这些网站之间未来合作的典范 资源互补。

Recent research has begun to support the hypothesis that by matching treatments to patient profiles, treatment outcomes can be enhanced Elaboration of this concept is needed what aspects of treatment are active in enhancing the effects on what dimensions of outcome for what kinds of patients? Given the fact of a "matching effect" it becomes even more important to test the generalizability of such effects. Does matching occur, irrespective of treatment program and setting? Do matching effects occur as much for poor and good prognosis patients alike? Can matching effects be observed in patient populations not volunteering for randomized clinical trials? The proposed study tests the hypothesis that the focus of two treatment modalities will enhance outcomes of patients when matched to predominant area of dysfunction. Patients characterized primarily by psychological dysfunction will benefit more when matched to an individually focused cognitive-behavioral therapy; patients whose dysfunction is predominantly social will benefit more from a Community Reinforcement Approach to treatment. The hypotheses are tested across three levels of treatment setting- inpatient. partial hospital and outpatient. Matching effects are examined for good and poor prognosis patients ' for clinically assigned patients as well as for those agreeing to random assignment. Different provider organizations are involved as performance sites: an HMO, a general hospital, and a community hospital specializing in chemical dependencies and addictions. To examine the active ingredients involved in treatment enhancement, theoretically focused measures of treatment are collected, and analyzed in relation to their effects upon relevant patient characteristics. Patients are followed for two years and outcome is measured i.n a multidimensional way. It is anticipated that results will have impact upon the everyday clinical setting It is also anticipated that the collaboration between a Clinical Research Center and clinical performance sites can serve as a model for future collaborations between these complementary resources.