Substance Abuse Treatment Systems: An Interorganizational Network Perspective

描述（由申请人提供）：在药物滥用治疗领域，“连续性护理”是指接受多层次的护理或治疗方式，从住院或住院到门诊和持续监测（McKay, 2009）。护理框架的连续性隐含着治疗提供者之间存在的组织间关系。药物滥用治疗文献中提到的“护理系统”假设这些“系统”是协调良好的。然而，对治疗系统的描述却表明情况恰恰相反。治疗系统是碎片化的，各种方式之间几乎没有协调（McLellan等人，2005；Saitz等人，2008）。在排毒出院时，患者复发的风险很高，因此容易受到系统故障的影响。为了改善弱势群体的护理系统，我们需要首先检查其结构和有效性（Morrissey, Johnsen, & Calloway, 1996）。拟议的研究和培训计划包括数据管理、网络分析和多层次分析方面的技能发展。该研究是第一个从组织间网络角度研究药物滥用治疗系统的研究。本申请中提出的研究是对县药物滥用治疗系统中组织间网络与再入院排毒之间关系的横断面分析研究。社会网络分析将用于衡量服务提供者之间的连通性。网络数据是病人出院后14天内从一个医生转到另一个医生的数据。社会网络分析是一种创新的研究策略，可以为药物滥用治疗护理系统的服务协调提供重要的见解。社会网络分析与卫生服务领域的相关性由最近的美国国立卫生研究院关于社会网络和健康的项目公告（PAR-10-146）证明。由于排毒服务的高成本和与持续药物滥用相关的健康风险，重新接受排毒是药物滥用治疗系统的重要绩效指标（McLellan等，2005）。这项研究集中在加利福尼亚州的47个县，这些县向该州报告了2008-2009年的戒毒数据。观察患者从一系列入院和出院到治疗提供者的途径，可以评估提供者之间的联系。该研究使用多级分析来预测患者再入院排毒（N=24,713）。该项目将分析来自两个管理数据库的数据：来自加州结果测量系统（CalOMS）的治疗事件数据，以及来自全国药物滥用治疗服务调查（N- SSATS）的设施级数据。在成瘾保健服务研究领域，组织间网络很少受到关注。提出的研究填补了这一空白，并为药物滥用治疗领域带来了更广阔的生态学视角。

DESCRIPTION (provided by applicant): In the field of substance abuse treatment, "continuity of care" refers to the receipt of multiple levels of care or treatment modalities, which range from inpatient or residential to outpatient and ongoing monitoring (McKay, 2009). Implicit in the continuity of care framework is the existence of interorganizational relationships among treatment providers. References to "systems of care" in the substance abuse treatment literature assume such "systems" are well-coordinated. Descriptions of the treatment system, however, suggest the opposite. Treatment systems are fragmented, with little coordination across modalities (McLellan et al., 2005; Saitz et al., 2008). At the point of discharge from detox, patients are at high risk of relapse and, therefore, vulnerable to system failures. To improve systems of care for vulnerable populations, we need to first examine their structure and effectiveness (Morrissey, Johnsen, & Calloway, 1996). The proposed research and training program includes skills development in data management, network analysis, and multi-level analysis. The proposed study is among the first to study substance abuse treatment systems from an interorganizational network perspective. The study proposed in this application is a cross-sectional, analytical study of the relationship between interorganizational networks in county substance abuse treatment systems and readmissions to detox. Social network analysis will be used to measure connectedness among service providers. The network data are patient transfers from one provider to another provider within 14 days of discharge. Social network analysis is an innovative research strategy that can provide important insights into services coordination in substance abuse treatment systems of care. The relevance of social network analysis to the health services field is evidenced by the recent NIH Program Announcement on Social Networks and Health (PAR-10-146). Because of the high cost of detox services and health risks associated with continued substance abuse, readmission to detox is an important performance measure for substance abuse treatment systems (McLellan et al., 2005). The study focuses on 47 counties in California that reported detox admission data to the state in 2008-2009. Observing the pathways of patients from series of admissions and discharges to and from treatment providers enables assessing connections among providers. The study uses multi-level analysis to predict patient readmission to detox (N=24,713). The project will analyze data from two from administrative databases: treatment episode data from the California Outcomes Measurement System (CalOMS), and facility-level data from the National Survey of Substance Abuse Treatment Services (N- SSATS). Interorganizational networks have enjoyed very little attention in the addiction health services research field. The proposed research fills this gap and brings a broader ecological perspective to the substance abuse treatment field. PUBLIC HEALTH RELEVANCE: The proposed research and training program is among the first to study substance abuse treatment systems from an interorganizational network perspective. The study proposed in this application is a cross-sectional, analytical study of the relationship between interorganizational networks in county substance abuse treatment systems and readmissions to detox. Archival data from the California Outcome Measurement System (CalOMS) will be used to map linkages among substance abuse treatment providers and measure services integration within provider networks.