Understanding Outcome Disparities in Alcohol Treatment

描述（由申请人提供）：酒精治疗结果的种族差异是一个全国性的问题。对于这些结果的差异，有许多可能的解释，包括获得治疗的不同途径，寻求和完成治疗的不同动机，以及文化和社会人口因素。邻居和其他环境因素以及先前的治疗经历也可能起作用。我们建议利用多层次建模方法对现有的酒精治疗数据进行二次数据分析。拟议的二次分析是对洛杉矶县酒精和药物治疗计划参与者1998年、1999年和2000年的年度数据集进行的，其中包括在公共资助的诊所为低收入客户提供的以少数群体为重点的治疗结果和非少数群体为重点的治疗结果。该分析将根据少数群体、地理和社区因素评估治疗的相对有效性，并揭示有助于取得积极结果的治疗方案特征。这些关于每个治疗方案的相对成功评级的信息将与治疗方案的成本/收益分析相结合。我们的分析方法结合了社区和地理因素的系统级数据，以及客户人口统计数据和治疗方案特征，这些都可能与治疗结果的差异有关。洛杉矶县是唯一适合解决这些关于治疗机会和结果差异的问题的地方。总人口超过950万，是高加索人、非洲裔美国人和拉丁美洲人的多种族混合（分别占总人口的31.1%、9.5%和44.6%）。本研究的具体目的如下：(1)确定患者人口统计学、地理位置、治疗方案与治疗结果的种族差异之间的关系；(2)确定非裔美国人、拉美裔美国人和白种人的治疗结果差异模式是否因性别和种族而异

DESCRIPTION (provided by applicant): Racial disparities in alcohol treatment outcomes are a national problem. There are a number of possible explanations for these disparities in outcomes, including differential access to treatment, different motivations to seek and complete treatment, as well as cultural and sociodemographic factors. Neighborhood and other environmental triggers may also play a role, as well as prior treatment experience. We propose a secondary data analyses of existing alcohol treatment data, utilizing a multilevel modeling approach. The proposed secondary analysis is of the Los Angeles County Alcohol and Drug Treatment Program Participant annual data sets for years 1998, 1999 and 2000, which contain minority focused as well as non-minority focused treatment outcomes in publicly funded clinics for low income clients. The analysis will evaluate the relative effectiveness of the treatments in terms of minority groups, geographic and neighborhood factors, as well as reveal the treatment program characteristics that contribute to positive outcomes. This information about the rating of relative success of each treatment program will be combined with a cost/benefit analysis of treatment programs. Our analytical approach incorporates system level data on neighborhoods and geographic factors, as well as client demographics, and treatment program characteristics, which may all be related to disparities in treatment outcomes. The county of Los Angeles is uniquely appropriate to address these questions regarding disparities in treatment access and outcome. With a total population of over 9.5 million, and with a multiracial mix of Caucasians, African-Americans and Latinos (31.1 %, 9.5% and 44.6% of the total county population, respectively). The specific aims of the proposed research are as follows: (1) to determine the relationship of client demographics, geographic location, and treatment program and racial disparities in treatment outcomes; (2) to determine if the patterns of disparities in treatment outcomes differ by gender and by race for African Americans, Latinos and Caucasians