EXTENDED CASE MONITORING FOR ALCOHOLICS--HEALTH COSTS

这项研究的基本目标是找到方法， 管理酒精问题患者的治疗， 以最低的成本为患者提供最佳的长期结果 对社会的贡献我们认为，从一个特定的角度来评估酒精治疗是至关重要的。 长期的观点，因为酗酒是一种复发性疾病， 社会、健康和经济影响往往被推迟。临床 对饮酒结果测量产生短期影响的策略 可能会或可能不会对结局指标产生实质性的长期影响， 医疗保健或其他具有重大社会利益的费用。在 这个项目，我们将研究后续计划的有效性 监测和转诊临床结果和长期保健 使用酒精的病人登记在HMO。患者将被随机分配 扩展病例监测与标准治疗。延伸案例 监测计划旨在增强现有的有效性， 成瘾治疗服务，而不是取代他们。干预将 帮助确保患者与医疗保健系统保持联系 在治疗后的一段时间内，复发的风险是 特别高，而且，在较低的强度水平， 在这两年里，复发的风险仍然很高。的 病例监测和转诊干预旨在成为一种低成本的 可由经过最低限度临床培训的人员提供的方案 并且因此每年每个患者的成本低。案例展示 干预本身不会进行任何治疗，而是评估 并在适当情况下转介病人接受现有的治疗服务。的 干预设计的基本原理基于所使用的方案 在其他心理健康领域的成功，在成瘾方面的先前研究， 关于社会支持的文献，以及复发的模型。这种积极主动的 与患者及其家属保持联系的系统， 旨在弥补现有治疗系统的缺陷 向酗酒者提供治疗服务， 根据他们在严重危机点的需求，而不是他们的 实际需求水平。在目前的分娩系统下， 可以从临床干预中受益，但在他们没有寻求服务之前， 情况已经严重恶化。更早重新开始治疗 应该改善平均结果水平，从长远来看， 通过最大限度地减少对高水平护理的需要来处理 严重的危机。

The fundamental goal of this line of research is to find approaches to managing the treatment of patients with alcohol problems that produce the best possible long-term outcomes for patients at the lowest possible cost to society. We feel it is critical to evaluate alcohol treatments from a long-term perspective since alcoholism is a recurrent disorder whose social, health, and economic effects are often delayed. Clinical strategies that produce short-term effects on drinking outcome measures may or may not have substantial long-term impact on outcome measures such as health care or other costs which are of substantial social interest. In this project, we will study the effectiveness of a program of followup monitoring and referral on the clinical outcome and long-term health care use of alcohol patients enrolled in an HMO. Patients will be randomized into extended case monitoring vs. standard treatment. The extended case monitoring program is designed to augment the effectiveness of existing addictions treatment services, not to replace them. The intervention will help ensure that patients stay in contact with the health care system during a period immediately after treatment when the risk of relapse is especially high, and also, at a lower level of intensity, for a followup period of two years during which risk of relapse remains elevated. The case monitoring and referral intervention is designed to be a low-cost protocol that can be delivered by personnel with minimal clinical training and therefore low cost per patient per year. The Case Monitors who deliver the intervention will not themselves do any treatment, but rather assess and refer patients, where appropriate, to existing treatment services. The rationale for the intervention design is based upon protocols used successfully in other mental health fields, prior research in addictions, the literature on social support, and models for relapse. This proactive system for maintaining contact with patients and their families is intended to remedy a defect in the present system of delivering treatment to alcohol abusers, in which treatment services are provided to patients on the basis of their demand at points of acute crisis rather than their actual level of need. Under the current delivery system, many patients who could benefit from clinical intervention fail to seek services until their situation has deteriorated substantially. Earlier re-entry into treatment should improve average outcome levels and over the long run reduce health care costs by minimizing the need for high levels of care to deal with severe crises.