Treatment Settings for Alcoholics: A Field Extension

描述(由申请人提供)： 此医疗服务应用程序是我们的 先前的工作是评估酗酒者的治疗设置。我们之前的研究， 在临床研究环境中进行的研究发现，患有 病情越严重，住院治疗比门诊治疗受益更多。 对于所有客户来说，相对于门诊患者，住院治疗导致 减少住院治疗或监禁的总天数 随访18个月。这些发现很重要，因为住院护理是 变得越来越稀缺，因为人们认为更便宜的 门诊治疗对所有个人都同样有效。此外，在 缺乏经验性的安置标准、护理水平 确定往往显得循环和低效(例如，进入住院患者 治疗必须先在门诊失败)。我们的发现表明，更多 有效的护理水平的确定是可能的。要解决这些问题 进一步的问题，我们建议在社区领域测试我们早先的发现 通过基于酒精的预期匹配和不匹配客户端进行设置 住院患者的参与程度和/或认知功能水平 门诊护理。在市中心诊所接受治疗的客户 纽约州布法罗的伊利县医疗中心(ECMC)将被分配到 住院患者需求组(基于酗酒和认知功能 水平)，并在每一组内随机分配到(A)21天 ECMC的住院护理加上六个月的持续门诊护理。 治疗将是客户在各自国家接受的标准治疗 程序。所有患者将在入院后18个月内接受随访(12 持续门诊护理后几个月)，并根据 自愿戒酒天数和非自愿戒毒天数的主要结果衡量 禁欲(即监禁、居留治疗等)。在基础上建设 我们之前的工作，该提案旨在为一个小型但重要的机构做出贡献 了解高效和有效的客户安置标准。

DESCRIPTION (provided by applicant): This health services application is a field replication and extension of our prior work evaluating treatment settings for alcoholics. Our prior research, conducted in a clinical research environment, found that individuals with a more severe problem benefited more from inpatient than outpatient treatment. For all clients, in patient treatment, relative to outpatient, resulted in fewer combined days of residential treatment or incarceration throughout the 18 month follow-up. These findings are important since inpatient care is becoming increasingly scarce due to the perception that less expensive outpatient treatment is equally effective for all individuals. Moreover, in the absence of empirically-derived placement criteria, level of care determinations often appear circular and inefficient (i.e., to enter inpatient treatment one has to fail outpatient first). Our findings suggest that more efficient level of care determinations may be possible. To address these issues further, we propose to test our earlier findings in a community field setting by prospectively matching and mismatching clients based on alcohol involvement level and/or level of cognitive functioning to either inpatient or outpatient care. Clients presenting for treatment at the Downtown Clinic of the Erie County Medical Center (ECMC), Buffalo, NY will be assigned to inpatient need group (based on alcohol involvement and cognitive functioning levels) and, within each group, randomly assigned to either (a) 21 days of inpatient care at ECMC plus six months of continuing outpatient care. Treatment will be the standard treatment received by clients in the respective programs. All clients will be followed over 18 months following admission (12 months post-continuing outpatient care) and evaluated with respect to the primary outcome measures of voluntary abstinent days and days of involuntary abstinence (i.e., incarceration, residential treatment, etc.). Building on our prior work, the proposal aims to contribute to a small but important body of knowledge on efficient and effective client placement criteria.