Treatment for Complex Patients: Continuing and Extended Care

描述（由申请人提供）：这是当前资助的中心补助金的竞争延续，“新环境中复杂患者的治疗”。在这种延续中，旧金山治疗研究中心（以下简称“中心”）对持续和扩展的护理模式进行了综合关注。中心近5年来成果丰硕，发表、出版科研论文190篇。中心结构包括4个组成部分的研究。第一部分是一项卫生服务研究，测试将药物滥用持续护理纳入医疗初级保健环境的干预措施，而第二部分是一项临床试验，测试在接受阿片类替代疗法者中治疗烟草依赖的延伸护理方法。组件3连接组件2，研究成瘾和恢复的神经和神经认知底物。组成部分4是一项交叉研究，使用来自两个主要组成部分（组成部分1和2）的数据和参与者，研究持续护理治疗模式中人群中多种危险行为的患病率、协方差和变化，第二项分析研究参加药物滥用治疗的吸烟者亚组，以便根据他们的具体需求定制烟草依赖治疗。围绕这些组成研究并提供科学领导和基础设施的是科学和行政核心以及统计和卫生经济学核心。最后，利用中心及其资源作为培训和发展新的和有前途的研究人员的平台是研究培训核心。在长期成功研究复杂患者的基础上，该中心通过测试持续护理治疗模式进行创新，以更好地为这些患者服务，通过增加其多学科能力，包括神经学、神经认知和探索性遗传学研究，通过将治疗研究和卫生服务研究整合到中心的方法中。并通过在公共卫生系统和私人管理的卫生保健系统中测试持续和扩展的护理模式。

DESCRIPTION (provided by applicant): This is a competing continuation of a currently funded Center Grant, "Treatments for Complex Patients in New Settings." In this continuation the San Francisco Treatment Research Center (hereafter, "Center") has an integrating focus on continuing and extended models of care. The Center has been productive during the past 5 years, with 190 scientific articles published or in press. The Center structure includes 4 component studies. Component 1 is a health services research study testing an intervention to bring drug abuse continuing care into medical primary care settings, while component 2 is a clinical trial testing an extended care approach to the treatment of tobacco dependence among persons receiving opiate replacement therapy. Components 3 attaches to Component 2 to investigate neurological and neurocognitive substrates of addiction and recovery. Component 4 is a cross-cutting study employing data and participants from both main components (Components 1 and 2) to study prevalence, covariance and change in multiple risk behaviors among persons in continuing care models of treatment, and a secondary analysis studies subgroups of smokers enrolled in drug abuse treatment in order to tailor tobacco dependence treatment to their specific needs. Wrapped around these component studies and providing scientific leadership and infrastructure are a Scientific and Administrative Core and a Statistics and Health Economics Core. Finally, using the Center and its resources as a platform to train and develop new and promising researchers is the Research Training Core. Building on its longstanding and successful research focused on complex patients, the Center innovates by testing continuing care models of treatment to better serve these patients, by increasing its multidisciplinary capabilities to include neurological, neurocognitive and exploratory genetics research, by integrating both treatment research and health services research into the Center's approach, and by testing continuing and extended care models in public health systems as well as in private managed health care systems. PUBLIC HEALTH RELEVANCE: Drug abuse is increasingly recognized as a chronic and relapsing condition, yet there are few practicable approaches to continuing care. This Center will test models of continuing and extended care for drug abuse treatment, including nicotine dependence, and will increase our understanding of how drug-related brain injury affects the process of treatment for, and recovery from, drug abuse. If these continuing care models are found to be effective, they will offer treatment systems practical and effective strategies for longer term and more effective drug abuse treatment. CENTER CHARACTERISTICS: