Medicaid Managed Care & Access to Alcohol Treatment

描述(由申请人提供)：该项目已被完全重新设计，包括描述和分析部分，以解决有酒精问题的医疗补助客户的治疗利用情况。 这个话题仍然具有重要意义，因为医疗补助在过去十年中经历了实质性的变化，因为各州已经用卡特尔等管理式医疗系统取代了服务项目的费用。个别州的早期研究表明，这些变化可能对医疗补助客户使用酒精和药物滥用治疗服务产生了相当大的影响。然而，目前还没有关于这些问题的已发表的全国性研究。 该项目将利用治疗事件数据集、医疗补助资格文件、统一设施数据系统、物质和精神卫生服务管理局的管理护理跟踪系统、全国州酒精和药物滥用主管协会年度调查以及其他国家数据集中包含的信息。将合并国家数据，以便在每年的基础上获得各州的信息。将制作表格和图表，描述有酒精问题的医疗补助客户在州药物滥用治疗政策和服务使用方面的变化。 在该项目的分析阶段，研究人员将生成医疗补助客户获得酒精和药物滥用治疗服务的统计模型，这些模型根据各州和医疗补助登记人数、治疗计划可用性和医疗补助人口中酒精问题流行率等协变量的逐年变化进行调整。将测试与服务使用、客户严重程度和治疗方式随时间变化有关的假设。研究人员将探索将分层模型和潜在变量增长曲线应用于国家数据集。这一结果将引起州医疗补助和酒精药物滥用项目负责人的极大兴趣。

DESCRIPTION (provided by applicant): This project has been completely re-designed to have both descriptive and analytical components addressing treatment utilization by Medicaid clients with alcohol problems. This topic remains significant since Medicaid has undergone substantial change in the last decade as states have replaced fee for service programs with managed care systems such as capitation. Early studies in individual states indicate that these changes may have had considerable impact on Medicaid clients' use of alcohol and drug abuse treatment services. However, there are no published national studies pertaining to these issues. The project will make use of information contained in the Treatment Episode Data Set, Medicaid Eligibility file, Uniform Facility Data System, the Substance and Mental Health Services Administration's Managed Care Tracking System, the National Association of State Alcohol and Drug Abuse Directors annual surveys, and other national data sets. The national data will be combined so as to obtain information on a state by state and year by year basis. Tables and graphs will be produced describing changes in state substance abuse treatment policies for and use of services by Medicaid clients with alcohol problems. In the analytic phase of the project the researchers will generate statistical models of access to alcohol and drug abuse treatment services by Medicaid clients that adjust for state by state and year by year variation in Medicaid enrollment, treatment program availability, and prevalence of alcohol problems in the Medicaid population, among other covariates. Hypotheses pertaining to changes over time in service use, client severity, and treatment modality will be tested. The investigators will explore application of hierarchical models and latent variable growth curves to the national data sets. The results will be of considerable interest to state Medicaid and alcohol drug abuse program directors.