IMPACTS OF MANAGED CARE ON SA SERVICE LINKAGES

这个为期三年的项目将侧重于影响在全国范围内提供药物滥用服务的一个重要问题：对涉及门诊药物滥用服务的服务关系实施管理式护理供资机制。最近的一些调查结果表明，采用管理式医疗供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关系的数量和/或强度。然而，这些研究中有许多涉及组织内部关系而不是组织间关系，对此我们知之甚少。调查结果还表明，药物滥用服务对同时患有精神健康和药物滥用障碍的人最有效，如果他们同时接受针对这两种障碍的服务，并且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，可能会破坏当地的医疗服务系统。本研究的重点是了解哪些服务关系涉及引入或加强管理护理支付做法的提供者服务的人滥用药物和精神健康障碍。这项研究将采用面对面调查的方式，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个站点中，每个站点至少有一个门诊药物滥用组织，从目前正在进行的不同研究中确定，并与适当的应答者一起确定。这个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其他当地精神卫生、职业和初级卫生保健服务提供者，以及其组织或服务项目的属性。此外，这些其他确定的组织也接受了采访，并被问及类似的一系列问题。组织间网络方法和这些药物滥用提供者与其他当地支持性护理提供者之间关系的二元分析将用于确定管理式护理对控制重要环境、组织或背景因素的这些服务联系的影响。该项目将使用纵向数据设计来构建适当的关系模型。调查结果将与参与为这一弱势群体提供适当和响应性护理的项目经理和主管进行联系和沟通。

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.