Impact of health reform on outpatient substance abuse treatment programs

描述(由申请人提供)：规模较小(平均15名全职工作人员)、资源不足的组织构成了门诊药物滥用治疗系统(OSAT)，在美国提供大多数药物滥用治疗。2010年《患者保护和平价医疗法案》(PPACA)的实施将极大地改变这些组织的组织环境。无论对PPACA的宪法挑战结果如何，医疗补助计划的扩大、医疗保险交易所的发展以及将药物滥用治疗纳入基本福利方案的任务，都将极大地扩大其医疗保险覆盖OSAT服务的美国人的数量，从而改变OSAT计划的付款人组合。强调综合护理模式，包括以患者为中心的医疗之家和负责任的护理组织，为护理协调创造了激励。这些改革将在OSAT护理的筹资、组织和获得方面产生彻底的变化。这项拟议的研究应用开放系统和资源依赖理论来审查医疗改革的两个主要方面--扩大保险和鼓励将药物滥用治疗与主流医疗保健相结合--这两个方面可能会影响OSAT计划的组织反应(即技术的使用、人员配备、从属关系和联盟)以及药物滥用治疗的可及性和质量。尽管如此，PPACA面临着法律、政治、财政和实施方面的不确定性。组织理论表明，这种不确定性将增加OSAT计划对获得运作和生存所需资源的担忧，导致组织之间更紧密的结盟和合并。拟议的研究将明确模拟这种环境不确定性，将其作为组织应对措施的一个调节因素。我们将在2013年夏季对500个具有全国代表性的OSAT计划样本进行调查，以检查OSAT计划在多大程度上适应新的组织环境。我们还建议对50个治疗药物滥用的单一国家机构的主任进行半结构化访谈，并与主要立法利益攸关方进行深入的定性访谈，以评估国家准备工作和PPACA的预期变化。通过重新调查2015年冬季的500个OSAT方案，我们将确定PPACA实施后对OSAT组织反应和服务提供的影响。通过将调查和访谈数据与2000年至2005年期间收集的国家药物滥用治疗系统调查(NDATSS)的数据联系起来，将形成一个小组数据集，这将提供在颁布PPACA和2008年《精神健康平等和成瘾平等法》之前OSAT方案和服务的真实基线。这项研究将使我们能够检查医疗改革对国家OSAT系统的影响，并向政策制定者和利益攸关方提供高质量的信息，以评估PPACA在改善药物滥用治疗的可及性和质量方面的有效性。1

DESCRIPTION (provided by applicant): Small (average of 15 full-time staff members), under-resourced organizations that comprise the outpatient substance abuse treatment (OSAT) system provide most drug abuse treatment in the United States. Implementation of the Patient Protection and Affordable Care Act (PPACA) of 2010 will dramatically change the organizational environment for these organizations. Regardless of the outcome of the constitutional challenge to PPACA, the expansion of Medicaid, the development of Health Insurance Exchanges and the mandate to include substance abuse treatment in essential benefits packages will greatly expand the number of Americans whose health insurance covers OSAT services and thus alter the payer mix in OSAT programs. The emphasis on integrated models of care, including patient-centered medical homes and Accountable Care Organizations, creates incentives for care coordination. These reforms will generate sweeping changes in the financing, organization and accessibility of OSAT care. The proposed study applies open systems and resource dependence theory to examine two major aspects of health reform - the expansion of insurance and incentives for integration of substance abuse treatment with mainstream health care - that are likely to influence OSAT programs' organizational responses (i.e. use of technology, staffing, affiliations and alliances) as well as the accessibility and quality of drug abuse treatment. That said, the PPACA faces legal, political, fiscal, and implementation uncertainties. Organizational theory suggests that such uncertainties will increase OSAT programs' concerns about obtaining resources necessary for functioning and survival, leading to closer alignment and mergers among organizations. The proposed study will explicitly model this environmental uncertainty as a moderator of OSAT organizational responses. We will survey a nationally-representative sample of 500 OSAT programs in summer 2013 to examine the extent to which OSAT programs are acting in anticipation of the new organizational environment. We also propose semi-structured interviews with the directors of the 50 single-state agencies for substance abuse treatment and in-depth qualitative interviews with key legislative stakeholders to assess state preparations and anticipatory changes from the PPACA. By re-surveying the 500 OSAT programs in winter 2015 we will determine the post-implementation impact of the PPACA on OSAT organizational responses and service delivery. A panel data set will be formed by linking the survey and interview data to data from the National Drug Abuse Treatment System Survey (NDATSS) collected during 2000 and 2005, which will provide a true baseline of OSAT programming and services prior to enactment of both the PPACA and the Mental Health Parity and Addiction Equity Act of 2008. This study will enable us to examine the impact of health reform on the nation's OSAT system and provide high-quality information to policy makers and stakeholders to evaluate the effectiveness of the PPACA in improving the accessibility and quality of substance abuse treatment. 1