Improving Care Continuity in Drug Abuse Treatment

住院治疗是任何治疗系统中最理想的治疗方式之一。然而，它也是最昂贵的一种治疗方法，如果不能在门诊项目中持续进行可靠的术后护理，它的好处是有限的。本服务研究项目将检验三种基于证据的干预措施的比较有效性，以改善历史上较低的从住院治疗到门诊治疗的成功过渡率。该项目在巴尔的摩市的治疗服务提供系统内进行，代表了约翰霍普金斯大学SOM，国家药物滥用治疗临床试验网络（CTN）中大西洋节点和巴尔的摩药物滥用系统（BSAS）之间的合作。要检查的干预措施是a)在出院当天将住院客户送到门诊转诊项目门口的运输护送，b)客户过渡激励，为成功注册门诊后护理的客户提供经济激励，以及c)安排住院服务。门诊部工作人员对住院项目的转介病人进行定向访问。这些增强的干预措施将与没有特殊干预措施的常规护理控制条件进行比较。采用拉丁广场交叉设计，最大限度地提高外部有效性，治疗条件将在为期两年的项目中按预先确定的顺序每隔6周进行一次。主要结果测量将是在住院出院后30天内接受门诊治疗的转诊患者的百分比。在门诊项目中停留的时间长度也将作为过渡干预的功能进行检查，作为次要结果。总体而言，该项目将提供宝贵的新数据，供决策者选择治疗过渡方案时使用，从而最大限度地提高药物滥用治疗服务提供系统内护理的连续性。

Residential treatment is one of the most desirable modalities offered in any treatment system. Yet it is also one of the most costly, and its benefits are limited if not followed reliably by continuing aftercare in an outpatient program. This services research project will examine the comparative effectiveness of three evidence-based interventions for improving historically low rates of successful transition from residential to outpatient care. The project takes place within the treatment service delivery system of Baltimore City and represents a collaboration between Johns Hopkins University SOM, the Mid Atlantic Node of the National Drug Abuse Treatment Clinical Trials Network (CTN) and Baltimore Substance Abuse Systems (BSAS), the Substance abuse authority for the City of Baltimore. The interventions to be examined are a) Transportation Escort that delivers residential clients to the door of the outpatient referral program on the day of discharge, b) Client Transition Incentive that offers a financial incentive to clients who successfully enroll in outpatient aftercare and c) Residential In-reach that arranges. orientation visits by outpatient staff who visit referral clients at the residential program. These enhanced interventions will be compared with a usual care control condition in which no special intervention is in place. Using a Latin Square cross-over design than maximizes external validity, treatment conditions will be in place during 6-week intervals of time in a pre-determined sequence during the 2-year project. Primary outcome measure will be the percent of referred clients who are admitted to an outpatient aftercare program within 30 days of residential discharge. Length of stay in the outpatient program will also be examined as a function of transition interventions as a secondary outcome. Overall, the project will provide valuable new data that can be used by policy makers to select treatment transition options that will maximize continuity of care within a drug abuse treatment services delivery system.