Case-Mix Adjustment for Adolescent Treatment Evaluations

描述（由申请人提供）： 消费者、购买者、服务提供者和政策制定者希望青少年酒精和其他药物（AOD）治疗服务的质量和问责制。与主流医疗保健服务相比，用于衡量提供者绩效和推动质量改进的护理质量指标对于一般的AOD治疗服务，尤其是青少年服务来说还不发达。在缺乏质量指标的情况下，我们建议开发工具，方法和理论，将支持使用基于结果的绩效衡量系统，以构建提供者基准，或提供者的有效性的标准化分数。州和联邦结果监测系统已经收集了接受治疗的青少年的结果数据。三个新的药物滥用治疗中心（CSAT）的举措可能会大大增加收集的此类数据的数量。虽然结果监测系统的设计，以确保问责制和质量的提高，没有更好地了解预处理的特点，在确定治疗结果的作用，可靠的病例组合调整方法，这些系统不能支持强有力的结论提供者的有效性。在我们最近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服务在三级护理中开发风险调整的结果模型（短期住院、长期住院和门诊戒毒治疗），以及一系列结果，包括吸毒问题的严重程度、犯罪行为、心理功能，社会功能和教育/职业功能。我们的目标是：1）建立青少年治疗前特征对他们的AOD治疗服务结果的影响的模型，2）评估这些模型作为青少年治疗服务提供者的原型性能基准系统的使用，以及3）开发和传播基准工具的版本，用于由服务提供者、CSAT、项目评估者和治疗研究人员检查青少年AOD治疗的有效性。我们希望这项研究的结果能够为制定护理质量指标的努力做出重要贡献，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.