Family Members of Alcohol Patients Utilization and Cost

描述(由申请人提供)：这项研究的目的是调查接受化学依赖(CD)计划的人的配偶和子女的卫生保健利用和费用，以及医疗和精神状况。如果CD治疗患者的家庭成员比一般家庭成员中的人有更高的费用和使用率，并且如果这些人受到CD治疗的影响，这将对治疗的成本效益产生影响。很少有研究关注有酒精或毒品问题的人的家庭成员的费用和利用情况，更少的研究能够评估治疗对他们的影响。我们建议对1241名患者的3011名家庭成员进行研究，这些患者在北加州凯撒永久CD恢复计划中接受治疗。CD样本收集了广泛的访谈数据，包括5年的治疗结果。使用KP电子数据库，我们将收集家庭成员以及从普通健康计划成员中随机选择的大型比较组成员的6年费用、利用率和诊断相关数据。在调整了年龄、性别、家庭大小和其他个人和家庭特征后，我们将调查CD患者的配偶和子女是否比对照组有更高的费用和利用(以及不同类型的利用，如住院和急诊室)，以及治疗结果是否影响费用差异。我们还将调查与对照组相比，CD患者的家属是否有更高的医疗和精神状况。在研究治疗结果对家庭利用的作用时，我们使用了一个模型，该模型包括以下特征：治疗样本(例如，人口统计学和问题特征)、家庭环境(例如，家庭压力源和家庭组成)以及治疗(例如，治疗结果和再入院)与家庭成员利用的关系。我们将使用线性和非线性混合模型来调查成本和利用率的差异。这些模型适当地处理了重复测量和家庭内部相关性，同时对重要的混杂因素进行了调整。我们的大量样本和大量详细的自我报告和长期的自动化数据将使我们能够回答重要的流行病学和卫生政策问题，这些问题包括酒精和毒品问题对家庭成员利用的影响、家庭成员的医疗需求以及这些问题的治疗对家庭成员的影响。

DESCRIPTION (provided by applicant): The aim of this study is to investigate the health care utilization and costs, and the medical and psychiatric conditions, for spouses and children of persons admitted to a chemical dependency (CD) program. If family members of CD treatment patients have higher costs and utilization than persons from a general membership sample of families, and if these are affected by CD treatment, this would have implications for the cost-effectiveness of treatment. Few studies have looked at costs and utilization of family members of persons with alcohol or drug problems, and fewer still have been able to assess the effect on them of treatment. We propose to study 3011 family members of 1241 patients who were admitted to treatment at a Northern California Kaiser Permanente (KP) CD recovery program. Extensive interview data, including 5 year treatment outcomes, have been collected on the CD sample. Using KP electronic databases we will collect 6 years of cost, utilization and diagnostic-related data for the family members, as well as for members of a large comparison group of families randomly selected from the general health plan membership. We will investigate whether the spouses and children of the CD patients have higher costs and utilization (and different types of utilization such as inpatient and ER) than the comparison group, after adjusting for age, gender, family size and other individual and family characteristics, and whether treatment outcome affects the cost differences. We will also investigate whether family members of CD patients have heightened medical and psychiatric conditions compared to the comparison group. In investigating the role of treatment outcome on family utilization, we use a model that includes characteristics of: the treatment sample (e.g., demographic and problem characteristics), the family environment (e.g., family stressors and family composition), and treatment (e.g., treatment outcome and readmissions) in their relationship to family members' utilization. We will use linear and non-linear mixed models to investigate cost and utilization differences. These models appropriately handle repeated measures and intra-family correlation, while adjusting for important confounders. Our large sample and wealth of detailed self-report and automated data over a long period of time will allow us to answer important epidemiologic and health policy questions regarding the effect on utilization of having family members with alcohol and drug problems, the medical needs of family members, and the effect on family members of the treatment of those problems.