IMPACTS OF MANAGED CARE ON SA SERVICE LINKAGES

这一为期三年的项目将重点关注影响全国药物滥用服务提供的一个重要问题：在涉及门诊药物滥用服务的服务关系上实施管理性医疗资助机制。最近的一些调查结果表明，采用管理保健筹资做法减少了精神健康和药物滥用障碍患者护理提供者之间的关系数量和/或强度。然而，这些研究中的许多都涉及组织内关系，而不是组织间关系，而我们对此知之甚少。调查结果还表明，药物滥用服务对于同时患有精神健康和药物滥用障碍的人来说是最有效的，如果他们同时接受这两种疾病的服务，并接受适当数量的服务。管理式医疗由于其减少服务使用和定义提供者网络的做法，可能会扰乱当地的医疗服务系统。这项研究的重点是了解为药物滥用和精神健康障碍患者提供服务的提供者引入或加强管理性护理付费做法会牵涉到哪些服务关系。这项研究将使用面对面的调查，从美国60个地点的大约420家服务提供商那里收集数据。在60个地点中的每个地点，至少有一个门诊药物滥用组织与适当的受访者一起被确定，该组织是根据目前正在进行的不同研究确定的。此人被要求在其组织的药物滥用障碍患者服务网络中确定最多六个当地心理健康、职业和初级卫生保健护理提供者，以及他们组织或服务计划的属性。此外，这些其他已确定的组织也接受了面谈，并被问到一系列类似的问题。组织间网络方法和对这些药物滥用提供者和其他当地支持性护理提供者之间随时间变化的关系的二元分析将被用来确定管理性护理对这些服务链接的影响，控制重要的环境、组织或背景因素。该项目将使用纵向数据设计来构建适当的关系模型。调查结果将被关联并传达给项目经理和主管，他们致力于为这一弱势群体提供适当和反应迅速的护理。

This three year project will focus on an important issue affecting the delivery of substance abuse services across the nation: the implementation of managed care funding mechanisms on the service relationships involving outpatient substance abuse services. Some recent findings suggest that the introduction of managed care funding practices decreases the number and/or intensity of relationships among providers of care for persons with mental health and substance abuse disorders. Many of these studies however involve intra rather than interorganizational relationships, of which we know little. Findings also show that substance abuse services are most effective for persons with both mental health and substance abuse disorders if they receive services for both disorders concomitantly and receive an appropriate number of them. Managed care, with its practices of decreasing service use and defining provider networks, may have the consequence of disrupting the local service system of care. This study is focused on understanding which service relationships are implicated by the introduction or the intensification of managed care payment practices for providers serving persons with substance abuse and mental health disorders. This study will use in-person surveys to collect data from approximately 420 service providers in 60 sites across the US. In each of 60 sites at least one outpatient substance abuse organization, determined from a different study currently underway, is identified along with an appropriate respondent. This person is asked to identify up to six other local providers of care of mental health, vocational, and primary health care in their organization's service network for persons with substance abuse disorders along with attributes of their organization or service program. In addition, these other identified organizations are also interviewed and asked a similar set of questions. Interorganizational network methods and dyadic analysis of the relationships over time between these substance abuse providers and other local providers of supportive care will be used to determine the impact of managed care on these service linkages controlling for important environmental, organizational, or contextual factors. The project will use a longitudinal data design to build appropriate relational models. Findings will be related and communicated to program managers and directors who are engaged in providing appropriate and responsive care to this vulnerable population.