A MULTISITE MATCHING OF TREATMENT FOCUS TO DYSFUNCTION

最近的研究已经开始支持这一假设，即通过匹配 根据患者资料进行治疗， 这一概念的确立需要哪些方面的治疗是 积极加强对成果的哪些方面的影响， 各种病人？考虑到"匹配效应"的事实， 更重要的是检验这种效应的普遍性。并 匹配发生，无论治疗方案和设置？做 对于预后不良和良好的患者来说，匹配效应同样存在 很像吗是否可以在患者人群中观察到匹配效应， 自愿参加随机临床试验 拟议的研究测试的假设，两个治疗的重点 当与主要治疗方法匹配时， 功能障碍区。患者主要表现为心理 当与一个单独关注的人相匹配时， 认知行为疗法;功能障碍主要是 社会将从社区强化方法中受益更多， 治疗在三个治疗水平上对假设进行检验 设置-住院。部分医院和门诊。匹配效果是 检查预后良好和不良患者的临床分配 患者以及同意随机分配的患者。不同 提供者组织作为绩效站点参与其中：HMO、 综合医院和一家社区医院，专门从事化学 依赖和成瘾。 为了检查参与治疗增强的活性成分， 收集并分析了理论上集中的治疗措施， 关于它们对相关患者特征的影响。 患者随访2年，并在体内测量结果。 多维方式预计结果将产生影响 在日常临床环境中，还预计 临床研究中心和临床性能之间的合作 网站可以作为未来合作的模式， 补充资源。

Recent research has begun to support the hypothesis that by matching treatments to patient profiles, treatment outcomes can be enhanced Elaboration of this concept is needed what aspects of treatment are active in enhancing the effects on what dimensions of outcome for what kinds of patients? Given the fact of a "matching effect" it becomes even more important to test the generalizability of such effects. Does matching occur, irrespective of treatment program and setting? Do matching effects occur as much for poor and good prognosis patients alike? Can matching effects be observed in patient populations not volunteering for randomized clinical trials? The proposed study tests the hypothesis that the focus of two treatment modalities will enhance outcomes of patients when matched to predominant area of dysfunction. Patients characterized primarily by psychological dysfunction will benefit more when matched to an individually focused cognitive-behavioral therapy; patients whose dysfunction is predominantly social will benefit more from a Community Reinforcement Approach to treatment. The hypotheses are tested across three levels of treatment setting- inpatient. partial hospital and outpatient. Matching effects are examined for good and poor prognosis patients ' for clinically assigned patients as well as for those agreeing to random assignment. Different provider organizations are involved as performance sites: an HMO, a general hospital, and a community hospital specializing in chemical dependencies and addictions. To examine the active ingredients involved in treatment enhancement, theoretically focused measures of treatment are collected, and analyzed in relation to their effects upon relevant patient characteristics. Patients are followed for two years and outcome is measured i.n a multidimensional way. It is anticipated that results will have impact upon the everyday clinical setting It is also anticipated that the collaboration between a Clinical Research Center and clinical performance sites can serve as a model for future collaborations between these complementary resources.