Organizational Factors in Drug Abuse Treatment Outcomes

药物滥用治疗结果的组织因素

• 批准号: 7069130
• 负责人: Robert Loren Stout
• 金额: $ 58.9万
• 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/7069130
• 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)： 该项目将提供有关临床层面的组织特征如何影响药物滥用结果的基本知识。药物滥用治疗机构具有高度多样化的组织特征。虽然来自管理型医疗的压力可能减少了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实际上如何影响长期临床结果，几乎没有严格的经验性信息。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的影响达成科学的理解。 该项目有以下具体目标：(1)进行多点纵向研究，以测试组织因素如何影响临床结果的预测，以及(2)测试关于组织变量影响临床结果的过程的假设。我们计划从20个不同的门诊药物治疗项目中招募500名客户。参与者将在入选后6个月和12个月接受彻底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，我们将研究多水平统计结果模型中组织水平预测因素的影响，以及预期影响结果的基线个人客户特征。这个统计模型将允许我们测试控制患者特征(病例组合)的组织特征的影响。我们还将测试组织变量的影响如何通过客户定制/响应能力进行中介的模型，即组织检测和适应其客户的优势和需求的能力。除了管理式医疗外，还有许多原因表明有效运营药物诊所很重要。我们认为，迫切需要进行严格的、理论驱动的实证研究，以便就提供戒毒治疗服务的最佳方式提供指导，以产生可能的最佳结果。