Case-Mix Adjustment for Adolescent Treatment Evaluations

描述(由申请人提供)： 消费者、购买者、服务提供商和政策制定者希望青少年酒精和其他药物(AOD)治疗服务的质量和责任感。与主流医疗服务相比，AOD治疗服务，特别是青少年服务，缺乏衡量提供者表现和推动质量改进的护理质量指标。在缺乏质量指标的情况下，我们建议开发工具、方法和理论，以支持使用基于结果的业绩衡量系统来构建提供者基准，或提供者有效性的标准化评分。州和联邦结果监测系统已经收集了有关接受治疗的青少年的结果数据。药物滥用治疗中心(CSAT)的三项新举措可能会极大地增加收集的此类数据的数量。尽管结果监测系统旨在确保问责制和质量改进，但如果没有更好地了解预处理特征在决定治疗结果中的作用，以及可靠的病例组合调整方法，这些系统不能支持关于提供者有效性的有力结论。在我们最新的病例组合调整创新的基础上，我们建议使用CSAT和NIDA收集的近4000名接受治疗的青少年的结果数据，为青少年AOD服务在三个护理级别(短期住院治疗、长期住院治疗和门诊非药物治疗)以及包括药物使用问题严重性、犯罪行为、心理功能、社会功能和教育/职业功能在内的一系列结果开发风险调整结果模型。我们的目标是：1)模拟青少年的预处理特征对其AOD治疗服务结果的影响，2)评估这些模型作为青少年治疗服务提供者的原型绩效基准系统的使用，以及3)开发和传播基准工具的版本，以供服务提供者、CSAT、项目评估者和治疗研究人员用于检查青少年AOD治疗的有效性。我们期待这项研究的结果将为制定护理质量指标的努力提供重要贡献，这些指标将有助于推动青少年AOD治疗服务的改善。

DESCRIPTION (provided by applicant): Consumers, purchasers, service providers and policymakers want quality and accountability in alcohol and other drug (AOD) treatment services for adolescents. In contrast to mainstream healthcare services, quality of care indicators with which to measure provider performance and drive quality improvements are underdeveloped for AOD treatment services generally, and adolescent services in particular. In the absence of quality indicators, we propose to develop tools, methods and theories that will support use of outcomes-based performance measurement systems to construct provider benchmarks, or standardized scores of providers' effectiveness. Outcomes data on treated adolescents are already collected by state and federal outcomes monitoring systems. Three new Center for Substance Abuse Treatment (CSAT) initiatives may dramatically increase the quantity of such data collected. Although outcomes monitoring systems are designed to ensure accountability and quality improvement, without improved understanding of the role of pretreatment characteristics in determining treatment outcomes, and reliable case-mix adjustment methods, these systems cannot support strong conclusions on provider effectiveness. Building on our recent case-mix adjustment innovations we propose to use outcomes data collected by CSAT and NIDA on nearly four thousand treated youths to develop risk adjusted outcomes models for adolescent AOD services in three levels of care (short term residential, long term residential and outpatient drug-free treatment), and for a range of outcomes including drug use problem severity, criminal behavior, psychological functioning, social functioning, and educational/vocational functioning. Our aims are to: 1) model the effects of adolescents' pretreatment characteristics on their AOD treatment service outcomes, 2) evaluate use of these models as a prototype performance benchmarking system for adolescent treatment service providers, and 3) develop and disseminate versions of the benchmarking tool for use in examining adolescent AOD treatment effectiveness by service providers, CSAT, program evaluators, and treatment researchers. We expect the results from this study to offer important contributions to efforts to develop quality of care indicators that will help to drive improvements in adolescent AOD treatment services.