Disease Management for Chronic Drug Abuse

描述（由申请人提供）：长期难治性酒精和其他药物（AOD）障碍患者仍然是州政府面临的一个棘手挑战。与其他慢性疾病一样，一小部分患者承担了不成比例的治疗费用。通常，这些客户在危机发作期间循环往复，先是高成本的护理，然后是协调不力的善后护理。作为主要的支付者，州和县机构不仅关心AOD治疗（TX）的低效支出，而且必须为这些个人提供多种危机服务。最近，各州一直在转向疾病管理项目（DMP），以控制医疗补助计划（Medicaid）治疗慢性病的成本。尽管他们的承诺，只有适度的科学证据表明dmp对医疗保健的有效性，没有对AOD障碍。纽约州刚刚启动了一项为期3年、耗资2500万美元的示范试点项目，向23个县提供赠款，为高成本的AODTX使用者提供病例管理服务。这项针对PAR-05-150的时间敏感R01应用旨在利用这一示范来建立和严格测试一种针对慢性成瘾（DM-CA）的创新疾病管理干预措施。应用程序是时间敏感的，因为干预和评估必须在2007年夏季之前得到资助，以利用演示。纽约州酗酒和药物滥用服务办公室（OASAS）和两个县将与我们的研究小组合作，开发和严格测试DM-CA。DM-CA将是一种系统级干预，其框架来自于封装在慢性护理模式中的卫生保健方面的最新创新。DM-CA的目的是改善护理的监测和协调，以避免危机事件（例如急诊科就诊），并帮助客户参与稳定门诊服务，从而降低保健费用。在两年多的时间里，OASAS将确定1700名高成本的AOD紊乱患者（即，在前一年使用1万美元的AODTX），然后在县内随机分配他们到DM- CA或常规护理（UC）的控制条件，不包括病例管理或DMP服务。将从广泛的行政记录中收集客户特征和结果。主要目的将检查1)危机事件的减少，2)门诊AODTX数量的增加，3)艾滋病毒/丙型肝炎病毒检测和咨询的可能性的增加，4)与干预相关的医疗补助成本的减少。

DESCRIPTION (provided by applicant): Individuals with long-standing, treatment refractory alcohol and other drug (AOD) disorders remain a vexing challenge for State governments. As with other chronic diseases, a small proportion of clients absorb a disproportionate share of treatment dollars. Often these clients cycle through crisis episodes with bouts of high-cost care followed by poorly coordinated aftercare. As the primary payers, state and county agencies not only are concerned with inefficient spending for AOD treatment (TX) but also must contend with supporting multiple crisis services for these individuals. Recently states have been turning to disease management programs (DMP) to control Medicaid costs of caring for chronic illnesses. Despite their promise, there is only modest scientific evidence of the effectiveness of DMPs for healthcare, and none for AOD disorders. New York State (NYS) just initiated a 3-year, $25 million demonstration pilot that provides grants to 23 counties to provide case management services to high-cost utilizers of AODTX. This time sensitive R01 application in response to PAR-05-150 seeks to capitalize on this demonstration to mount and rigorously test an innovative disease management intervention for chronic addiction (DM-CA). The application is time-sensitive because the intervention and evaluation must be funded by summer of 2007 to take advantage of the demonstration. The NYS Office of Alcoholism and Substance Abuse Services (OASAS) and two counties will partner with our research group to develop and rigorously test DM-CA. The DM-CA will be a system level intervention with a framework drawn from recent innovations in health care encapsulated in the Chronic Care Model. DM-CA will be designed to improve monitoring and coordination of care in order to avert crisis events (e.g., ED visits) and help engage clients in stabilizing outpatient services, thereby reducing health care costs. Over two years, OASAS will identify 1,700 high cost AOD disordered clients (i.e., using >=$10k of AODTX in the prior year) and then randomly assign them within county to DM- CA or a control condition of usual care (UC), consisting of no case management or DMP services. Client characteristics and outcomes will be collected from extensive administrative records. Primary Aims will examine 1) reductions in crises events, 2) increases in number of outpatient AODTX, 3) increases in likelihood of HIV/HCV testing & counseling, 4) Medicaid cost reductions associated with the intervention.