Organizational Factors in Drug Abuse Treatment Outcomes

药物滥用治疗结果的组织因素

• 批准号: 6733309
• 负责人: Robert Loren Stout
• 金额: $ 58.66万
• 依托单位: PACIFIC INSTITUTE FOR RES AND EVALUATION
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-07-15 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6733309
• 关键词: clinical research; drug abuse; drug abuse therapy; health care quality; health care service; human subject; human therapy evaluation; interview; longitudinal human study; mathematical model; outcomes research; psychometrics

DESCRIPTION (provided by applicant): This project will provide fundamental knowledge on how clinic-level organizational characteristics affect drug abuse outcomes. Drug abuse treatment organizations have highly diverse organizational characteristics. While pressure from managed care may have reduced the services provided and managerial resources available, clinics have responded to reimbursement pressures in a variety of different ways. There is, however, little rigorous, empirical information about how varied characteristics and procedures actually affect long-term clinical outcomes. We feel there are compelling reasons to believe that how clinics are run can have important effects on outcome, and therefore a need to achieve a scientific understanding of what aspects make the most difference. The project has the following specific aims: (1) To conduct a multi-site longitudinal study to test predictions about how organizational factors affect clinical outcome, and (2) to test hypotheses about the processes by which organizational variables affect clinical outcomes. We propose to recruit 500 clients from 20 diverse outpatient drug treatment programs. Participants will receive a thorough baseline assessment and follow-up interviews at 6 and 12 months after intake. At the same time, we will conduct assessments of the clinical settings that will include clinical and structural aspects. In the data analysis, we will study the effects of organizational-level predictors in a multilevel statistical outcome model, jointly with baseline individual client characteristics expected to affect outcome. This statistical model will allow us to test for the impact of organizational characteristics controlling for patient characteristics (case mix). We will also test a model of how the effects of organizational variables are mediated by client customization/responsiveness, the capacity of an organization to detect and adapt to the strengths and needs of its clients. There are many reasons, beyond managed care, why it is important to run drug clinics effectively. We feel there is a critical need for rigorous, theoretically driven empirical research to provide guidance on the best ways to deliver drug treatment services to produce the best possible outcomes.

描述（由申请人提供）： 该项目将提供有关诊所层面的组织特征如何影响药物滥用结果的基础知识。药物滥用治疗组织具有高度多样化的组织特征。虽然管理式医疗的压力可能减少了所提供的服务和可用的管理资源，但诊所以各种不同的方式应对报销压力。然而，关于不同的特征和程序如何实际影响长期临床结果，几乎没有严格的经验信息。我们认为有令人信服的理由相信诊所的运营方式会对结果产生重要影响，因此需要对哪些方面产生最大影响有一个科学的理解。 该项目有以下具体目标：（1）进行多中心纵向研究，以测试有关组织因素如何影响临床结果的预测，以及（2）测试有关组织变量影响临床结果的过程的假设。我们建议从 20 个不同的门诊药物治疗项目中招募 500 名客户。参与者将在入学后 6 个月和 12 个月接受全面的基线评估和后续访谈。同时，我们将对临床环境进行评估，包括临床和结构方面。在数据分析中，我们将研究多级统计结果模型中组织级预测因素的影响，以及预期影响结果的基线个人客户特征。该统计模型将使我们能够测试控制患者特征（病例组合）的组织特征的影响。我们还将测试一个模型，该模型显示组织变量的影响如何通过客户定制/响应能力（组织检测和适应客户的优势和需求的能力）来调节。除了管理式医疗之外，有效运营药物诊所的重要性还有很多原因。我们认为迫切需要严格的、理论驱动的实证研究，为提供药物治疗服务的最佳方式提供指导，以产生最佳的可能结果。