EXTENDED CASE MONITORING FOR ALCOHOLICS--HEALTH COSTS

申请者摘要：这一研究方向的根本目标是 想方设法管理酒精问题患者的治疗 以尽可能低的成本产生尽可能好的长期结果 社会。对饮酒产生短期影响的临床策略 结果衡量标准可能会也可能不会对健康产生实质性的长期影响 护理或其他具有重大社会利益的费用。我们正在建造 根据关于后续监测和监测方案的影响的现有研究 关于酒精的临床结果和长期保健使用的转介 病人。我们的研究是第一个经过深思熟虑的研究 是为了最大限度地弥补酒精治疗的“成本”。我们正在延长 我们早期的研究是在日间医院的戒毒环境中进行的。 患者将随机进入改良和强化的病例监测 干预与标准治疗。这一监测计划旨在 加强现有成瘾治疗服务的有效性，而不是 换掉它们。干预措施将有助于确保患者与患者保持联系 与卫生保健系统进行了为期一年半的临床随访期。 这种干预措施可以以每位患者每年较低的成本进行。这个 干预设计的理论基础不仅仅是基于我们自己的先验 研究，也包括在其他心理健康领域成功使用的方案， 以前对成瘾的研究，关于社会支持的文献，以及 旧病复发。这个与患者保持联系的主动系统是 意在弥补现有系统中的一个缺陷，即向 酗酒者。现在，许多进入戒毒期的患者可能会受益 从进一步治疗未能寻求服务，直到他们的情况一次 再次大幅恶化。主动、持续地连接到 治疗服务，以及更早地重新进入治疗应该会改善平均水平 结果水平和长期而言，通过最大限度地减少医疗成本 需要高度的关怀来应对严重的危机。来自之前的数据 资金表明，干预措施具有积极的效果。新的资金将 使确定这些影响是否可以推广到 解毒设置，使我们能够测试关于 干预的作用机制，让我们得以实施和检验 协议的改进，并使我们能够更准确地确定 医疗费用变化的性质、时间进程和相关因素 酒精治疗。

APPLICANT'S ABSTRACT: The fundamental goal of this line of research is to find ways to manage the treatment of patients with alcohol problems that produce the best possible long-term outcomes at the lowest possible cost to society. Clinical strategies that produce short-term effects on drinking outcome measures may or may not have substantial long-term impact on health care or other costs which are of substantial social interest. We are building upon existing research on the impact of a program of follow-up monitoring and referral on the clinical outcome and long-term health care use of alcohol patients. Ours is the first modern study in which a deliberate effort has been made to maximize "cost offsets" from alcohol treatment. We are extending our earlier research done in day hospital settings to detoxification settings. Patients will be randomized into a modified and intensified case monitoring intervention vs. standard treatment. This monitoring program is designed to augment the effectiveness of existing addictions treatment services, not to replace them. The intervention will help ensure that patients stay in contact with the health care system over a clinical follow-up period of 1.5 years. The intervention can be delivered at a low cost per patient per year. The rationale for the intervention design is based not only on our own prior research but also protocols used successfully in other mental health fields, prior research in addictions, the literature on social support, and models for relapse. This proactive system for maintaining contact with patients is intended to remedy a defect in the present system of delivering treatment to alcohol abusers. Now, many patients entering detoxification who could benefit from further treatment fail to seek services until their situation has once again deteriorated substantially. A proactive, continuing connection to treatment services, and earlier re-entry into treatment should improve average outcome levels and over the long run reduce health care costs by minimizing the need for high levels of care to deal with severe crises. Data from prior funding indicate that the intervention has positive effects. New funding will make it possible to determine whether these effects can be generalized to detoxification settings, allow us to test further hypotheses about the mechanisms of action of the intervention, allow us to implement and test improvements in the protocol, and allow us to determine more accurately the nature, time course, and factors associated with changes in health costs after alcohol treatment.