Quality of Care in State Alcohol Treatment Systems

描述（由申请人提供）：本提案是申请号R21 AA 14195的修订版，该申请最初于2002年10月10日由国家酒精滥用和酒精中毒卫生服务研究审查小组委员会（AA-2）审查。根据审查人员的意见，对申请作了实质性修改。 该项目的动机仍然是对测量（并最终提高）治疗系统提供的医疗保健质量的日益增长的兴趣。国家在指导和资助酗酒者的治疗方面发挥主导作用。碰巧的是，各州在酒精治疗计划的几个方面存在明显差异，包括服务系统的支出和使用不同的治疗方式，如门诊与住院治疗。鉴于这种情况，合乎逻辑的是，询问各州是否可以根据其酒精治疗系统提供的护理质量进行排名。 与护理质量研究密切相关的是绩效衡量标准的制定。一个经常讨论的绩效指标是客户的治疗持续时间（也称为住院时间）。虽然证据并不明确，但有相当多的数据表明，治疗时间可以预测酒精问题患者的护理结果（包括饮酒，就业和犯罪活动）。因此，毫不奇怪，化学依赖项目的国家指南通常将治疗持续时间作为绩效衡量标准。此外，2002年12月，药物滥用和精神健康服务管理局宣布，住院时间将是绩效伙伴关系赠款制度的一项发展措施，该制度正在取代整笔赠款方案， 拟议的探索性/发展性项目将利用来自酒精和药物服务研究和类似研究、国家酒精和药物滥用项目主任协会、治疗事件数据集和统一设施数据集的全国范围的数据，以制定各州和逐年治疗持续时间的措施。 反过来，住院时间指标将进行调整，以考虑各州和各年客户严重程度的差异（“病例组合差异”）。该研究的产品将包括各州在护理质量指标上的排名（即，治疗持续时间）。护理质量排名将与州酒精治疗计划的其他方面进行比较，如支出和能力。采用这些方法的初步工作提出了一种令人不安的可能性，即支出充其量与护理质量无关。 因此，方法和结果将是相当大的兴趣，酒精治疗的客户，政策制定者和付款人。

DESCRIPTION (provided by applicant): This proposal is a revision of application number R21 AA 14195 which was originally reviewed October 10, 2002 by the National Institute on Alcohol Abuse and Alcoholism Health Services Research Review Subcommittee (AA-2). The application has been substantially revised in response to the reviewers' comments. Motivation for the project remains the growing interest in measuring (and, eventually, improving) the quality of health care provided by treatment systems. States have dominant roles in the direction and financing of treatment for people with alcohol problems. As it happens, there is marked variation from state to state in several aspects of alcohol treatment programs including expenditures for service systems and use of different treatment modalities such as outpatient versus residential care. Given this situation, it is logical to ask whether states can be ranked on the quality of care delivered by their alcohol treatment systems. Closely linked to quality of care research is the development of performance measures. A frequently discussed performance measure is the client's duration of treatment (also known as length of stay). While the evidence is not unequivocal, there is considerable data suggesting that treatment duration predicts care outcomes (including drinking, employment, and criminal activity) for people with alcohol problems. Not surprisingly, then, national guidelines for chemical dependency programs often include treatment duration as a performance measure. Moreover, in December, 2002 the Substance Abuse and Mental Health Services Administration announced that length of stay will be a developmental measure in the Performance Partnership Grant system which is replacing the block grant program, The proposed exploratory/developmental project will utilize nation-wide data from the Alcohol and Drug Services Study and similar studies, the National Association of State Alcohol and Drug Abuse Program Directors, the Treatment Episode Data Set, and the Uniform Facility Data Set to develop measures of treatment duration on a state by state and year by year basis. The length of stay indicators, in turn, will be adjusted to account for variations in client severity ("case mix differences") across states and years. Products of the study will include rankings of the states on a quality of care measure (i.e., treatment duration). The quality of care rankings will be compared with other aspects of state alcohol treatment programs such as expenditures and capacity. Preliminary work employing these methods has raised the disturbing possibility that expenditures are at best unrelated to quality of care. Consequently, the methodology and the results will be of considerable interest to alcohol treatment clients, policy makers, and payers.