IMPACTS OF MANAGED CARE ON SA SERVICE LINKAGES

管理式医疗对 SA 服务联系的影响

• 批准号: 6352515
• 负责人: Joseph P. Morrissey
• 金额: $ 4.59万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-02-20 至 2003-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6352515
• 关键词: behavioral /social science research tag; clinical research; data collection methodology /evaluation; drug abuse therapy; health care service availability; health care service evaluation; health care service planning; health services research tag; human subject; interview; longitudinal human study; managed care; patient care personnel relations; questionnaires; statistics /biometry; substance abuse related disorder

This three year project will focus on an important issue affecting the delivery of substance abuse services across the nation: the implementation of managed care funding mechanisms on the service relationships involving outpatient substance abuse services. Some recent findings suggest that the introduction of managed care funding practices decreases the number and/or intensity of relationships among providers of care for persons with mental health and substance abuse disorders. Many of these studies however involve intra rather than interorganizational relationships, of which we know little. Findings also show that substance abuse services are most effective for persons with both mental health and substance abuse disorders if they receive services for both disorders concomitantly and receive an appropriate number of them. Managed care, with its practices of decreasing service use and defining provider networks, may have the consequence of disrupting the local service system of care. This study is focused on understanding which service relationships are implicated by the introduction or the intensification of managed care payment practices for providers serving persons with substance abuse and mental health disorders. This study will use in-person surveys to collect data from approximately 420 service providers in 60 sites across the US. In each of 60 sites at least one outpatient substance abuse organization, determined from a different study currently underway, is identified along with an appropriate respondent. This person is asked to identify up to six other local providers of care of mental health, vocational, and primary health care in their organization's service network for persons with substance abuse disorders along with attributes of their organization or service program. In addition, these other identified organizations are also interviewed and asked a similar set of questions. Interorganizational network methods and dyadic analysis of the relationships over time between these substance abuse providers and other local providers of supportive care will be used to determine the impact of managed care on these service linkages controlling for important environmental, organizational, or contextual factors. The project will use a longitudinal data design to build appropriate relational models. Findings will be related and communicated to program managers and directors who are engaged in providing appropriate and responsive care to this vulnerable population.

这个为期三年的项目将侧重于影响在全国范围内提供药物滥用服务的一个重要问题：在涉及门诊药物滥用服务的服务关系上实施管理式护理供资机制。 最近的一些研究结果表明，采用管理式护理供资做法减少了为精神健康和药物滥用障碍患者提供护理的人员之间关系的数量和/或强度。 然而，许多这些研究涉及内部而不是组织间的关系，我们知道的很少。 研究结果还表明，药物滥用服务是最有效的人与精神健康和药物滥用障碍，如果他们同时接受服务，这两种疾病，并收到适当数量的。 管理式护理的做法是减少服务使用和界定提供者网络，这可能会破坏当地的护理服务系统。本研究的重点是了解哪些服务关系所牵连的引入或加强管理式医疗支付的做法，为服务人员提供药物滥用和精神健康障碍。这项研究将使用面对面调查，从美国60个地点的约420家服务提供商收集数据。在60个研究中心中，每个研究中心至少有一个门诊药物滥用组织（根据目前正在进行的不同研究确定）与适当的应答者一起确定沿着。这个人被要求确定多达六个其他当地的精神健康，职业和初级卫生保健护理提供者在他们的组织的服务网络与物质滥用障碍的人沿着与他们的组织或服务计划的属性。 此外，还对这些其他已确定的组织进行了访谈，并提出了类似的问题。 组织间网络的方法和二元分析的关系，随着时间的推移，这些药物滥用提供者和其他当地提供者的支持性护理将被用来确定这些服务的联系控制重要的环境，组织，或上下文因素的影响管理式护理。 该项目将使用纵向数据设计来建立适当的关系模型。 调查结果将与参与为这一弱势群体提供适当和响应式护理的项目经理和主任联系并进行沟通。