EXTENDED CASE MONITORING FOR ALCOHOLICS : HEALTH COSTS

申请人摘要：本研究的基本目标是 找到方法来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 结果测量可能会或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。 我们正在建设 根据现有的关于后续监测方案的影响的研究， 关于酒精的临床结果和长期卫生保健使用的转诊 患者 我们的研究是第一个现代研究， 最大化酒精治疗的“成本补偿”。 我们正在扩展 我们早期的研究是在日间医院和戒毒所进行的。 患者将被随机分配至改良和强化的病例监测组 干预与标准治疗。 该监测方案旨在 提高现有成瘾治疗服务的有效性， 取代他们。 干预将有助于确保患者保持联系 在1.5年的临床随访期内， 干预可以以每年每位患者的低成本提供。的 干预设计的基本原理不仅基于我们自己的先验知识， 研究以及在其他心理健康领域成功使用的协议， 成瘾的先前研究，关于社会支持的文献，以及 复发 这种与病人保持联系的主动系统是 旨在弥补目前提供治疗的系统中的缺陷， 酗酒者现在，许多进入戒毒治疗的病人 在进一步治疗之前， 再次严重恶化。 主动、持续的连接， 治疗服务，并尽早重新进入治疗应改善平均 从长远来看，通过最大限度地减少 需要高水平的护理来应对严重的危机。 先前数据 资金表明，干预措施具有积极的效果。 新资金将 使我们有可能确定这些影响是否可以推广到 解毒设置，使我们能够测试进一步的假设， 干预的行动机制，使我们能够实施和测试 协议的改进，并允许我们更准确地确定 性质、时间进程和与医疗费用变化相关的因素， 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.