Quality of Care in State Alcohol Treatment Systems

州酒精处理系统的护理质量

• 批准号: 6731311
• 负责人: BENTSON H MCFARLAND
• 金额: $ 15.25万
• 依托单位: OREGON RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-02-13 至 2006-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6731311
• 关键词: alcoholism /alcohol abuse therapy; clinical research; disease /therapy duration; drug abuse therapy; geographic difference; health care cost /financing; health care quality; health care service evaluation; health services research tag; hospital length of stay; human data; time resolved data

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.

说明（由申请人提供）：本提案是申请号 R21 AA 14195 的修订版，该申请最初由国家酒精滥用和酒精中毒研究所健康服务研究审查小组委员会 (AA-2) 于 2002 年 10 月 10 日审查。根据审稿人的意见，该应用程序已进行了大幅修改。 该项目的动机仍然是人们对测量（并最终提高）治疗系统提供的医疗保健质量越来越感兴趣。国家在指导和资助酒精问题患者的治疗方面发挥着主导作用。事实上，各州在酒精治疗计划的几个方面存在显着差异，包括服务系统的支出以及不同治疗方式的使用，例如门诊与住院护理。鉴于这种情况，合乎逻辑的是询问各州是否可以根据其酒精治疗系统提供的护理质量进行排名。 与护理质量研究密切相关的是绩效衡量标准的制定。经常讨论的绩效衡量标准是客户的治疗持续时间（也称为住院时间）。虽然证据并不明确，但有大量数据表明，治疗持续时间可以预测有酒精问题的人的护理结果（包括饮酒、就业和犯罪活动）。因此，毫不奇怪，国家化学品依赖计划指南通常将治疗持续时间作为绩效衡量标准。此外，2002 年 12 月，药物滥用和心理健康服务管理局宣布，住院时间将成为绩效合作补助金制度中的一项发展措施，该制度正在取代整笔补助金计划， 拟议的探索/开发项目将利用来自酒精和药物服务研究和类似研究、全国州酒精和药物滥用项目主任协会、治疗发作数据集和统一设施数据集的全国范围数据，以逐年制定各州治疗持续时间的衡量标准。 反过来，停留时间指标将进行调整，以考虑不同州和年份的客户严重程度的变化（“病例组合差异”）。该研究的产品将包括各州在护理质量衡量标准（即治疗持续时间）方面的排名。护理质量排名将与州酒精治疗计划的其他方面（例如支出和能力）进行比较。采用这些方法的初步工作提出了令人不安的可能性，即支出充其量与护理质量无关。 因此，该方法和结果将引起酒精治疗客户、政策制定者和付款人的极大兴趣。