Case-Mix-Adjustment for Adolescent Treatment

描述（由申请人提供）：家长、购买者和其他利益相关者缺乏关于青少年通常可获得的酒精和其他药物（AOD）治疗服务质量的信息。基于结果的绩效衡量系统还不能确定有效的方案，并且很少有特定的护理质量指标被确定为AOD治疗。相反，州和联邦官员鼓励医疗机构采用基于研究的治疗方法。然而，即使这种方法也不能保证质量的提高，因为在社区项目中实施基于研究的治疗方法时，人们对其有效性知之甚少。在此更新申请中，我们建议制定护理质量指标，以此为基础建立青少年AOD治疗的质量改进体系。为了支持这一目标，SAMHSA的药物滥用治疗中心及其应用研究办公室将为我们的团队提供超过15,000名青少年的数据集，在入院时和12个月后进行全面的访谈。SAMHSA将把这些记录与全美100多个治疗病例的项目的组织和设施特征的调查数据联系起来。利用这些非凡的数据资源和我们开发的因果建模工具，我们提出了三个新的目标：(1)测试广泛传播的研究型治疗（MET/CBT5）是否能改善社区治疗方案的结果；(2)确定与良好的客户结果相关的护理质量指标；(3)确定向关键客户亚群（例如，患有共病精神障碍的客户）提供护理的质量指标。这一更新将使我们的富有成效的团队在我们长期顾问委员会的指导下，继续建立证据基础，有效的质量改进系统将需要青少年AOD服务。公共卫生相关性：该项目的目标是制定护理质量指标，以此为基础建立青少年酒精和其他药物治疗的质量改进系统。为了实现这一目标，我们将使用超过15,000名青少年的数据集，在入学时和12个月后进行全面的访谈，这将与美国100多个治疗病例的项目的组织和设施特征的调查数据相关联。通过实施这一研究计划，我们将解决NIDA卫生服务研究蓝带工作组确定的多个研究重点，包括评估CBTP环境下干预措施和实践的有效性，为创新的成功传播建立条件，以及澄清组织因素对结果的影响。

DESCRIPTION (provided by applicant): Parents, purchasers, and other stakeholders lack information on the quality of the alcohol and other drug (AOD) treatment services typically available to adolescents. Outcomes-based performance measurement systems cannot yet identify effective programs, and few specific quality of care indicators have been identified for AOD treatment. Instead, state and federal officials encourage providers to adopt research-based treatments. Even this approach does not ensure quality improvement, however, because little is known about the effectiveness of research-based treatments when they are implemented in community-based programs. In this renewal application, we propose to develop quality of care indicators on which quality improvement systems for adolescent AOD treatment can be built. In support of this objective, SAMHSA's Center for Substance Abuse Treatment and its Office of Applied Studies will provide our team with access to a dataset of more than 15,000 adolescents assessed with a comprehensive interview at intake and 12-months later. SAMHSA will link these records to survey data on the organizational and facility characteristics of the more than 100 programs across the U.S. where the cases were treated. Using these extraordinary data resources and the causal modeling tools we have developed, we propose three new aims: (1) Test whether adoption of a widely disseminated research-based therapy (MET/CBT5) improves outcomes at community-based treatment programs; (2) Identify quality of care indicators associated with good client outcomes; and (3) Identify quality indicators for care provided to key client subgroups (e.g., clients with co-morbid psychiatric disorders). This renewal will allow our productive team, under the guidance of our longstanding advisory board, to continue to build the evidence base that effective quality improvement systems for adolescent AOD services will require. PUBLIC HEALTH RELEVANCE: The goal of this project is to develop quality of care indicators on which quality improvement systems for adolescent alcohol and other drug treatment can be built. To accomplish this objective, we will use a dataset of more than 15,000 adolescents assessed with a comprehensive interview at intake and 12-months later, which will be linked to survey data on the organizational and facility characteristics of the more than 100 programs across the U.S. where the cases were treated. By pursuing this research plan, we will address multiple research priorities identified by NIDA's Blue Ribbon Task Force on Health Services Research, including evaluating the effectiveness of interventions and practices in CBTP settings, establishing conditions for successful diffusion of innovations, and clarifying the influence of organizational factors on outcomes.