Disease Management for Chronic Drug Abuse

描述（由申请人提供）：患有长期难治性酒精和其他药物（AOD）障碍的个人仍然是州政府面临的一个棘手挑战。与其他慢性病一样，一小部分患者承担了不成比例的治疗费用。这些客户通常在危机事件中循环，先是一轮又一轮的高成本护理，然后是协调不佳的善后护理。作为主要的支付者，州和县机构不仅关心AOD治疗（TX）的低效率支出，而且还必须为这些人提供多种危机服务。最近，各州一直在转向疾病管理计划（CDC），以控制医疗补助费用的照顾慢性病。尽管他们的承诺，只有适度的科学证据的有效性DMPs的医疗保健，并没有为AOD障碍。纽约州（NYS）刚刚启动了一项为期3年、耗资2500万美元的示范试点项目，向23个县提供赠款，为AODTX的高成本使用者提供案例管理服务。响应PAR-05-150的这一时间敏感的R 01应用寻求利用这一示范来安装和严格测试慢性成瘾的创新疾病管理干预（DM-CA）。申请具有时间敏感性，因为干预和评估必须在2007年夏季之前获得资金，才能利用演示。纽约州酗酒和药物滥用服务办公室（OASAS）和两个县将与我们的研究小组合作开发和严格测试DM-CA。DM-CA将是一个系统层面的干预措施，其框架来自慢性病护理模式中最近的医疗保健创新。DM-CA将旨在改善护理的监测和协调，以避免危机事件（例如，艾德就诊），并帮助客户参与稳定门诊服务，从而降低医疗保健成本。在两年内，OASAS将确定1,700个高成本AOD紊乱的客户（即，在前一年使用>=$10k的AODTX），然后在县内将他们随机分配到DM- CA或常规护理（UC）的对照条件，其不包括病例管理或护理服务。将从大量行政记录中收集客户特征和结果。主要目的将检查1）危机事件的减少，2）门诊AODTX数量的增加，3）HIV/HCV检测和咨询的可能性增加，4）与干预相关的医疗补助成本降低。

DESCRIPTION (provided by applicant): Individuals with long-standing, treatment refractory alcohol and other drug (AOD) disorders remain a vexing challenge for State governments. As with other chronic diseases, a small proportion of clients absorb a disproportionate share of treatment dollars. Often these clients cycle through crisis episodes with bouts of high-cost care followed by poorly coordinated aftercare. As the primary payers, state and county agencies not only are concerned with inefficient spending for AOD treatment (TX) but also must contend with supporting multiple crisis services for these individuals. Recently states have been turning to disease management programs (DMP) to control Medicaid costs of caring for chronic illnesses. Despite their promise, there is only modest scientific evidence of the effectiveness of DMPs for healthcare, and none for AOD disorders. New York State (NYS) just initiated a 3-year, $25 million demonstration pilot that provides grants to 23 counties to provide case management services to high-cost utilizers of AODTX. This time sensitive R01 application in response to PAR-05-150 seeks to capitalize on this demonstration to mount and rigorously test an innovative disease management intervention for chronic addiction (DM-CA). The application is time-sensitive because the intervention and evaluation must be funded by summer of 2007 to take advantage of the demonstration. The NYS Office of Alcoholism and Substance Abuse Services (OASAS) and two counties will partner with our research group to develop and rigorously test DM-CA. The DM-CA will be a system level intervention with a framework drawn from recent innovations in health care encapsulated in the Chronic Care Model. DM-CA will be designed to improve monitoring and coordination of care in order to avert crisis events (e.g., ED visits) and help engage clients in stabilizing outpatient services, thereby reducing health care costs. Over two years, OASAS will identify 1,700 high cost AOD disordered clients (i.e., using >=$10k of AODTX in the prior year) and then randomly assign them within county to DM- CA or a control condition of usual care (UC), consisting of no case management or DMP services. Client characteristics and outcomes will be collected from extensive administrative records. Primary Aims will examine 1) reductions in crises events, 2) increases in number of outpatient AODTX, 3) increases in likelihood of HIV/HCV testing & counseling, 4) Medicaid cost reductions associated with the intervention.