Family Members of Alcohol Patients: Utilization and Cost

描述（由申请人提供）：本续期申请响应国家酒精滥用和酒精中毒研究所PA-08- 263，药物和酒精滥用预防和治疗卫生服务研究（R01）。这项研究调查了一个重要的科学和政策问题，酒精和药物研究没有充分解决：有一个家庭成员有酒精或药物依赖（AODD）的影响是什么？对家庭成员的健康和社会心理问题的影响以及他们使用的额外卫生服务，以及由此对卫生系统造成的成本是什么？最初的研究比较了一个大型健康计划的参与者，他们的家庭成员被诊断为AODD，他们的家庭成员没有AODD，他们的家庭成员有其他慢性疾病（糖尿病和哮喘），使用了大量匹配的样本。为了更好地估计这些家庭对卫生系统的全部成本，我们建议检验原始研究中关于AODD患者家庭成员的更高成本和更多健康状况（以及在AODD指数成员接受成功的AODD治疗后家庭成本降低）的发现是否持续存在。我们使用了来自原始研究的大型，匹配良好的健康计划队列，其中我们分析了从指标家庭成员诊断为AODD的日期前1年到2年后的数据。我们建议再检查5年的数据，总研究期为8年。我们利用电子病历和其他健康计划数据的创新技术来检查家庭成员的医疗状况，并估计由于治疗而导致的利用变化。为了了解AODD家庭成员的使用和成本的长期趋势，并将其与其他人口统计学上相似的队列进行比较，我们将使用广义线性模型（用于年度比较）和分层线性模型（用于分析多年趋势）。我们将考察指标患者的依赖类型、接受非典型精神障碍治疗以及同时发生的医疗和精神疾病与家庭成员的利用和费用的关系，分别考察儿童和成人家庭成员的费用。我们还将AODD家庭成员与非AODD个体的家庭成员以及糖尿病和哮喘患者的家庭成员进行8年的比较。使用青少年的队列与AODD，我们检查他们的兄弟姐妹和父母的健康状况和成本。最后，通过图表回顾和其他健康计划数据，我们确定与比较家庭的儿童相比，AODD成人的儿童家庭成员是否更不可能获得最佳预防保健，或者更有可能有家庭、法律或学校问题的记录。该研究对诸如在初级保健中进行干预、在儿科中筛查家庭问题、将家庭成员作为AODD服务的一部分以及卫生政策（包括AODD福利在高价值卫生保健服务清单中，低成本分担）等关键问题具有重要意义。

DESCRIPTION (provided by applicant): This Renewal Application responds to the National Institute on Alcohol Abuse and Alcoholism PA-08- 263, Health Services Research on the Prevention and Treatment of Drug and Alcohol Abuse (R01). The study examines a significant scientific and policy issue that alcohol and drug research has not adequately addressed: what are the effects of having a family member with alcohol or drug dependence (AODD)? What are the effects on health and psychosocial problems of family members and the additional health services they use, and what are the resulting costs to the health system? The original study compared enrollees in a large health plan who have a family member diagnosed with AODD to family members of individuals without an AODD and family members of individuals with other chronic conditions (diabetes and asthma), using large matched samples. We propose to examine whether findings from the original study of higher costs and more health conditions among family members of persons with AODD (and reduced family costs after the index AODD member receives successful AODD treatment) persist over time in order to better estimate the full cost of these families to health systems. We use the large, well-matched health plan cohorts from the original study, in which we analyzed data from 1 year before the date of the index family member's AODD diagnosis to 2 years after. We propose to examine 5 additional years of data, for a total study period of 8 years. We use innovative techniques with electronic medical record and other health plan data to examine medical conditions of family members and to estimate utilization changes due to treatment. To understand the long-term trends in utilization and costs of AODD family members and compare them to other demographically similar cohorts, we will use generalized linear models (for yearly comparison) and hierarchical linear models (for analysis of multi-year trends). We will examine the relationships of the index patient's dependence type, receiving AODD treatment, and co-occurring medical and psychiatric conditions to the utilization and costs of their family members, examining cost for children and adult family members separately. We will also compare AODD family members with family members of individuals without AODD, and with family members of patients with diabetes and asthma over the 8 years. Using the cohort of adolescents with AODD, we examine the health conditions and costs of their siblings and parents. Finally, through chart review and other health plan data, we determine if the child family members of AODD adults are less likely to receive optimal preventive care, or are more likely to have records indicating family, legal, or school problems than children in the comparison families. The study has high significance for critical issues such as placing interventions in primary care, screening for family problems in pediatrics, treating family members as part of AODD services, and for health policy (including AODD benefits in the list of high value health care services, with low cost-sharing). PUBLIC HEALTH RELEVANCE: The study examines the medical conditions and health care utilization and costs of family members of adults and adolescents with alcohol or drug dependence (AODD) over 8 years, comparing them with family members of individuals without AODD and with family members of diabetes and asthma patients. It uses innovative IT methods and has significant clinical and policy implications for placing interventions in primary care, screening for family problems in pediatrics, and treating family members as part of AODD services.