Improving Clinician Ratings of Money Mismanagement: Addiction's Impact.

提高临床医生对资金管理不善的评级：成瘾的影响。

• 批准号: 8458987
• 负责人: Marc I Rosen
• 金额: $ 26.16万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8458987
• 关键词: Agreement; Alcohol or Other Drugs use; Alcohols; Beck depression inventory; Clinical; Data; Device or Instrument Development; Diagnosis; Diagnostic and Statistical Manual of Mental Disorders; Diagnostic tests; Disability Insurance; Disabled Persons; Disease; Equation; Evaluation; Evaluation Research; Factor Analysis; Food; Funding; Goals; Gold; Homelessness; Housing; Individual; Inpatients; Instruction; Insurance Benefits; Interview; Judgment; Left; Length of Stay; Logistic Regressions; Measures; Modeling; Outpatients; Patients; Pharmaceutical Preparations; Phase; Procedures; Questionnaires; ROC Curve; Recording of previous events; Regression Analysis; Research; Role; Sensitivity and Specificity; Series; Shelter facility; Social Security; Structure; Substance abuse problem; Supplemental Security Income; Testing; United States Social Security Administration; Validation; Work; addiction; alcohol and other drug; base; beneficiary; design; disability; disability payment; follow-up; improved; instrument; meetings; public health relevance; response

DESCRIPTION (provided by applicant): The goal of this study is to improve upon the current procedure for determining when patients with psychiatric and/or substance abuse disorders are incapable of managing their funds by developing and validating the CAFI (Clinician Assessment of Financial Incapability), a brief clinician-rated instrument to "diagnose" incapability. Disabled people are harmed when their Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits are misspent, often on drugs and alcohol, leaving them without money for housing and other essentials. A representative payee may be assigned to patients who are incapable of managing their funds but the Social Security Administration (SSA) largely decides on payee assignment based on a single question answered by the patient's clinician. Clinicians are given no instruction to consider substance abuse, despite its importance in managing funds. This study involves a Pre-Pilot Phase during which candidate items will be developed and tested, an Instrument Development Phase and an Instrument Validation Phase. In the Pre-Pilot phase, candidate items for the CAFI will be developed by the research team and piloted with 15 clinicians. Then, in the Instrument Development Phase, three sets of assessments will be conducted: (a) questionnaires with the single SSA question and the candidate items for the CAFI will be completed by clinicians treating 120 inpatients and patients in day hospitals with histories of substance abuse, and will be completed again one week later to identify items with adequate test-retest reliability, (b) all-data assessments of patients' capability to manage their funds will be completed by independent third-party experts using the L.E.A.D. procedure (Longitudinal Expert Evaluation Using All Available Data) applied to pre-defined criteria, and (c) clinical rating scales administered to patients by a research assistant. Individual item analysis, test-retest reliability, exploratory factor analysis and backwards stepwise logistic regression will be used to cull a brief questionnaire (the CAFI) from the candidate questionnaire with items that best identify beneficiaries incapable of managing their funds (as determined by the all data approach). In the Instrument Validation Phase, the CAFI and the battery of assessments (all-data evaluation, and research assistant ratings) will be collected for 192 patients at baseline. The sensitivity and specificity of each of the clinician assessments (single SSA question and CAFI) vis a vis the concurrent all-data assessment will be determined and the accuracy of the single SSA question and the CAFI will be compared using a z-test of differences between coefficients. The convergent validity of the single SSA question and the CAFI will be determined by comparing the agreement of each with clinical measures collected by the research assistant. Twenty-four weeks later, follow-up assessments will be collected by the research assistant and third-party experts to determine the predictive validity of the single SSA question and the CAFI. Analyses of the role of substance abuse in money mismanagement will be conducted.

描述（由申请人提供）：本研究的目的是通过开发和验证 CAFI（临床医生财务无能力评估）来改进确定患有精神和/或药物滥用疾病的患者何时无法管理其资金的现行程序，CAFI 是一种临床医生评定的用于“诊断”无能力的简短工具。当残疾人的补充保障收入 (SSI) 和社会保障残疾保险 (SSDI) 福利被滥用（通常用于吸毒和酗酒）时，他们就会受到伤害，导致他们没有钱购买住房和其他必需品。代表收款人可能会被分配给无法管理其资金的患者，但社会保障管理局 (SSA) 在很大程度上根据患者临床医生回答的一个问题来决定收款人的分配。尽管药物滥用在管理资金方面很重要，但临床医生没有得到任何关于考虑药物滥用的指示。这项研究包括一个预试点阶段，在此期间将开发和测试候选项目、仪器开发阶段和仪器验证阶段。在预试点阶段，CAFI 的候选项目将由研究团队开发，并由 15 名临床医生进行试点。然后，在仪器开发阶段，将进行三组评估：(a) 包含单一 SSA 问题的调查问卷和 CAFI 的候选项目将由治疗 120 名住院患者和日间医院有药物滥用史的患者的临床医生完成，并将在一周后再次完成，以确定具有足够的重测可靠性的项目，(b) 将对患者管理资金的能力进行全数据评估。 由独立第三方专家使用 L.E.A.D. 完成程序（使用所有可用数据的纵向专家评估）应用于预先定义的标准，以及（c）由研究助理对患者进行的临床评级量表。将使用单项分析、重测信度、探索性因素分析和向后逐步逻辑回归从候选问卷中筛选出一份简短的问卷（CAFI），其中包含最能识别无能力管理其资金的受益人的项目（由全数据方法确定）。在仪器验证阶段，将为 192 名患者收集基线的 CAFI 和一系列评估（所有数据评估和研究助理评级）。将确定每个临床医生评估（单个 SSA 问题和 CAFI）相对于并发所有数据评估的敏感性和特异性，并将使用系数之间差异的 z 检验来比较单个 SSA 问题和 CAFI 的准确性。单个 SSA 问题和 CAFI 的收敛有效性将通过将每个问题与研究助理收集的临床测量值的一致性进行比较来确定。 24 周后，研究助理和第三方专家将收集后续评估，以确定单个 SSA 问题和 CAFI 的预测有效性。将分析药物滥用在资金管理不善中的作用。