Treatment Settings for Alcoholics: A Field Extension

描述（由申请人提供）： 该健康服务应用程序是我们的现场复制和扩展 之前的工作评估了酗酒者的治疗设置。我们之前的研究， 在临床研究环境中进行的研究发现，具有 更严重的问题住院治疗比门诊治疗受益更多。 对于所有客户来说，在患者治疗中，相对于门诊患者，导致 整个地区住院治疗或监禁的总天数更少 18个月的随访。这些发现很重要，因为住院护理是 由于人们认为更便宜而变得越来越稀缺 门诊治疗对所有人都同样有效。此外，在 缺乏经验得出的安置标准、护理水平 决定往往显得循环且效率低下（即，进入住院病人 治疗必须先在门诊失败）。我们的研究结果表明，更多 有效的护理水平的确定是可能的。为了解决这些 进一步的问题，我们建议在社区领域测试我们早期的发现 通过基于酒精的前瞻性匹配和不匹配客户进行设置 住院患者或住院患者的参与水平和/或认知功能水平 门诊护理。在市中心诊所接受治疗的客户 纽约州布法罗的伊利县医疗中心 (ECMC) 将被分配到 住院患者需求组（基于酒精参与度和认知功能 水平），并且在每组内，随机分配到 (a) 21 天 ECMC 的住院护理加上六个月的持续门诊护理。 治疗将是客户在各自领域接受的标准治疗 程序。所有客户将在入院后 18 个月内接受跟踪（12 持续门诊护理后的几个月）并进行评估 自愿戒酒天数和非自愿戒酒天数的主要结果指标 禁欲（即监禁、住院治疗等）。建立在 我们之前的工作，该提案旨在为一个小而重要的机构做出贡献 关于高效和有效的客户安置标准的知识。

DESCRIPTION (provided by applicant): This health services application is a field replication and extension of our prior work evaluating treatment settings for alcoholics. Our prior research, conducted in a clinical research environment, found that individuals with a more severe problem benefited more from inpatient than outpatient treatment. For all clients, in patient treatment, relative to outpatient, resulted in fewer combined days of residential treatment or incarceration throughout the 18 month follow-up. These findings are important since inpatient care is becoming increasingly scarce due to the perception that less expensive outpatient treatment is equally effective for all individuals. Moreover, in the absence of empirically-derived placement criteria, level of care determinations often appear circular and inefficient (i.e., to enter inpatient treatment one has to fail outpatient first). Our findings suggest that more efficient level of care determinations may be possible. To address these issues further, we propose to test our earlier findings in a community field setting by prospectively matching and mismatching clients based on alcohol involvement level and/or level of cognitive functioning to either inpatient or outpatient care. Clients presenting for treatment at the Downtown Clinic of the Erie County Medical Center (ECMC), Buffalo, NY will be assigned to inpatient need group (based on alcohol involvement and cognitive functioning levels) and, within each group, randomly assigned to either (a) 21 days of inpatient care at ECMC plus six months of continuing outpatient care. Treatment will be the standard treatment received by clients in the respective programs. All clients will be followed over 18 months following admission (12 months post-continuing outpatient care) and evaluated with respect to the primary outcome measures of voluntary abstinent days and days of involuntary abstinence (i.e., incarceration, residential treatment, etc.). Building on our prior work, the proposal aims to contribute to a small but important body of knowledge on efficient and effective client placement criteria.