Linking State Data to Identify Unmet Alcohol Treatment Need in Women aged 15-49

描述（由申请人提供）：酒精治疗项目知道他们服务的对象，但只能估计他们不服务的对象；无法准确衡量未满足的治疗需求，特别是育龄妇女的治疗需求，是制定干预措施以减少与酒精有关的对妇女、其子女和社会的健康后果的一个主要障碍。该提案描述了一项创新的合作，将两个现有的独立的州数据系统连接起来，创建一个新的、独特的纵向流行病学数据库，将酒精/药物治疗数据与医院利用和健康结果数据结合起来，广泛地确定与酒精相关的问题和未满足治疗需求的普遍程度，并跟踪马萨诸塞州育龄妇女及其子女与酒精相关的健康结果。需要接受酒精治疗服务但未得到治疗的妇女将首次被单独确定，从而能够更好地估计和描述未满足的需求。新的关联数据将允许通过多种数据来源评估满足和未满足治疗需求的妇女之间的差异，包括使用经过测试的算法来识别医院数据中的酒精诊断。此外，相关数据将允许检查15-49岁妇女随后的健康结果及其子女的生育结果。要连接的两个数据源是：(1)以人口为基础的MA妊娠至早期生命纵向（PELL）数据系统，其中包括生命记录（出生、胎儿死亡和死亡）；出院、观察和急诊科就诊记录；以及MA出生缺陷登记处；(2) MA药物滥用服务局（BSAS）治疗数据系统，其中包含每年超过25,000名育龄妇女到BSAS资助的药物滥用治疗机构就诊的治疗记录。研究的三大目标是：1。将PELL数据链接到MDPH-BSAS治疗数据库并验证链接。2. 制定和试验方法a)在所有MA育龄妇女中，确定酗酒或酒精依赖妇女（2002-2007年），评估未满足的治疗服务需求，并确定治疗使用的总体和类型差异（无，仅戒毒，明确）；b) 2003-2006年，在分娩的MA妇女中，描述在怀孕前、怀孕期间和怀孕后酒精问题的识别和治疗模式，按类型和时间评估未满足的酒精治疗需求，并描述妊娠结果；c)在确定有酒精问题的MA妇女中建立初步的多变量模型，其中包含易患因素和使能因素，预测总体和按类型接受治疗的情况，并在分娩的妇女中预测早产风险。3. 根据本研究提出的双变量和多变量分析以及NIH/NIDA的串联研究，制定一项R01建议，描述药物滥用和治疗对妇女和儿童健康的影响。

DESCRIPTION (provided by applicant): Alcohol treatment programs know who they serve, but can only estimate who they do not serve; the inability to accurately measure unmet treatment need, especially among women of reproductive age, is a key barrier to developing interventions to reduce alcohol-related health consequences for women, their children, and society. This proposal describes an innovative collaboration to link two existing independent state data systems to create a new, unique longitudinal, epidemiologic database that combines alcohol/drug treatment data with hospital utilization and health outcomes data, to broadly identify alcohol-related problems and the prevalence of unmet treatment need, and to track alcohol-related health outcomes among Massachusetts women of reproductive age and their children. For the first time, women in need of alcohol treatment services who did not receive them will be individually identifiable, allowing for better estimation and description of unmet need. The new linked data will permit assessment of disparities among women with met and unmet treatment need through multiple sources of data, including using a tested algorithm to identify alcohol diagnoses in hospital data. Moreover, the linked data will allow the examination of subsequent health outcomes among women ages 15-49, and birth outcomes among their children. The two data sources to be linked are: (1) the population- based MA Pregnancy to Early Life Longitudinal (PELL) data system, that includes vital records (births, fetal deaths and deaths); hospital discharge, observational stay, and emergency department visit records; and the MA Birth Defects Registry; and (2) the MA Bureau of Substance Abuse Services (BSAS) treatment data system that contains treatment records for over 25,000 annual admissions of women of reproductive age to BSAS-funded substance abuse treatment facilities. The three broad study aims are: 1. Link PELL data to the MDPH-BSAS Treatment Database and verify linkages. 2. Develop and pilot methods a) among all MA women of reproductive age, identify women with alcohol abuse or dependence (2002-2007), assess unmet need for treatment services, and characterize disparities in treatment use, overall and by type (none, detox only, definitive); b) among MA women who had deliveries (2003-2006), describe the pattern of identification and treatment of alcohol problems in the periods before, during, and after pregnancy, assess unmet need for alcohol treatment by type and timing, and characterize pregnancy outcomes; and c) among MA women with an identified alcohol problem develop preliminary multivariate models with predisposing and enabling factors predicting receipt of treatment overall and by type, and, among women who delivered, risk for prematurity. 3. Develop an R01 proposal to describe the impact of substance abuse and treatment on women's and children's health, based on bivariate and multivariate analyses proposed for this study and a tandem NIH/NIDA study. PUBLIC HEALTH RELEVANCE: This innovative public-private collaboration links two existing independent state data systems (BSAS and PELL) to create a new, unique longitudinal, epidemiologic database that combines alcohol/drug treatment data with hospital utilization and health outcomes data, to broadly identify alcohol-related problems and the prevalence of unmet treatment need, and to track alcohol-related health and birth outcomes among Massachusetts women of reproductive age. For the first time, women in need of alcohol treatment services who did not receive them will be individually identifiable, allowing for accurate estimation and description of unmet need, a critical step to improve State alcohol treatment programs for women of reproductive age.