Quality of Care in State Alcohol Treatment Systems

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DESCRIPTION (provided by applicant): This proposal is a revision of application number R21 AA 14195 which was originally reviewed October 10, 2002 by the National Institute on Alcohol Abuse and Alcoholism Health Services Research Review Subcommittee (AA-2). The application has been substantially revised in response to the reviewers' comments. Motivation for the project remains the growing interest in measuring (and, eventually, improving) the quality of health care provided by treatment systems. States have dominant roles in the direction and financing of treatment for people with alcohol problems. As it happens, there is marked variation from state to state in several aspects of alcohol treatment programs including expenditures for service systems and use of different treatment modalities such as outpatient versus residential care. Given this situation, it is logical to ask whether states can be ranked on the quality of care delivered by their alcohol treatment systems. Closely linked to quality of care research is the development of performance measures. A frequently discussed performance measure is the client's duration of treatment (also known as length of stay). While the evidence is not unequivocal, there is considerable data suggesting that treatment duration predicts care outcomes (including drinking, employment, and criminal activity) for people with alcohol problems. Not surprisingly, then, national guidelines for chemical dependency programs often include treatment duration as a performance measure. Moreover, in December, 2002 the Substance Abuse and Mental Health Services Administration announced that length of stay will be a developmental measure in the Performance Partnership Grant system which is replacing the block grant program, The proposed exploratory/developmental project will utilize nation-wide data from the Alcohol and Drug Services Study and similar studies, the National Association of State Alcohol and Drug Abuse Program Directors, the Treatment Episode Data Set, and the Uniform Facility Data Set to develop measures of treatment duration on a state by state and year by year basis. The length of stay indicators, in turn, will be adjusted to account for variations in client severity ("case mix differences") across states and years. Products of the study will include rankings of the states on a quality of care measure (i.e., treatment duration). The quality of care rankings will be compared with other aspects of state alcohol treatment programs such as expenditures and capacity. Preliminary work employing these methods has raised the disturbing possibility that expenditures are at best unrelated to quality of care. Consequently, the methodology and the results will be of considerable interest to alcohol treatment clients, policy makers, and payers.