Organizational Factors in Drug Abuse Treatment Outcomes

药物滥用治疗结果的组织因素

• 批准号: 7272072
• 负责人: Robert Loren Stout
• 金额: $ 56.68万
• 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/7272072
• 关键词: Affect; Case Mixes; Characteristics; Client; Clinic; Clinical; Clinical assessments; Complex; Data Analyses; Drug Delivery Systems; Drug abuse; Effectiveness; Empirical Research; Individual; Intake; Interview; Knowledge; Longitudinal Studies; Managed Care; Mediating; Modeling; Outcome; Outpatients; Participant; Patients; Performance; Pharmaceutical Preparations; Procedures; Process; Rate; Recruitment Activity; Research Personnel; Resources; Running; Services; Site; Statistical Models; Structure; System; Testing; Time; Treatment outcome; drug abuser; falls; follow-up; improved; indexing; mouse Numb protein; pressure; programs; treatment organization; treatment program

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水平组织特征如何影响药物滥用结果的基本知识。药物滥用治疗组织具有高度多样化的组织特征。虽然托管护理的压力可能减少了提供的服务和可用的管理资源，但诊所对报销压力的反应各种不同。但是，几乎没有关于各种特征和程序如何实际影响长期临床结果的严格，经验信息。我们认为有令人信服的理由相信，如何运行诊所会对结果产生重要影响，因此需要对哪些方面产生最大的差异进行科学理解。 该项目具有以下具体目的：（1）进行多站点纵向研究，以测试有关组织因素如何影响临床结果的预测，以及（2）测试有关组织变量影响临床结果的过程的假设。我们建议从20个不同的门诊药物治疗计划中招募500名客户。参与者将在摄入量后6和12个月接受彻底的基线评估和后续采访。同时，我们将对将包括临床和结构方面的临床环境进行评估。在数据分析中，我们将在多级统计结果模型中研究组织级预测指标的影响，并共同具有预期影响结果的基线个人客户特征。该统计模型将使我们能够测试控制患者特征（病例混合）的组织特征的影响。我们还将测试一个模型，说明如何通过客户定制/响应能力来介导组织变量的效果，组织检测和适应客户的优势和需求的能力。除了托管护理之外，有很多原因有效地运营药物诊所很重要。我们认为，严格的，理论上驱动的经验研究的迫切需要，以提供提供药物治疗服务以产生最佳结果的最佳方法的指导。