Family Members of Alcohol Patients: Utilization and Cost

描述（由申请人提供）：本更新申请响应国家酒精滥用和酒精中毒研究所PA-08- 263，预防和治疗药物和酒精滥用的卫生服务研究（R 01）。这项研究探讨了酒精和药物研究尚未充分解决的一个重要的科学和政策问题：有酒精或药物依赖（AODD）的家庭成员的影响是什么？对家庭成员的健康和心理社会问题有何影响，他们使用的额外保健服务有何影响，以及由此给保健系统造成的费用是多少？最初的研究比较了一个大型健康计划中有家庭成员被诊断患有AODD的参与者与没有AODD的家庭成员和患有其他慢性疾病（糖尿病和哮喘）的家庭成员，使用大量匹配样本。我们建议检查是否从原来的研究结果更高的成本和更多的健康状况的家庭成员与AODD（和减少家庭成本后，指数AODD成员接受成功的AODD治疗）持续随着时间的推移，以更好地估计这些家庭的全部成本卫生系统。我们使用原始研究中的大型、匹配良好的健康计划队列，其中我们分析了索引家庭成员诊断AODD日期前1年至诊断后2年的数据。我们建议再检查5年的数据，总研究期为8年。我们使用创新的技术与电子医疗记录和其他健康计划数据，以检查家庭成员的医疗条件，并估计由于治疗的利用变化。为了了解AODD家庭成员利用率和成本的长期趋势，并将其与其他人口统计学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）。我们将研究索引患者的依赖类型，接受AODD治疗，并同时发生的医疗和精神疾病的利用和成本的家庭成员，分别检查儿童和成年家庭成员的成本的关系。我们还将比较AODD家庭成员与无AODD个体的家庭成员，以及8年内患有糖尿病和哮喘的患者的家庭成员。使用青少年与AODD队列，我们检查他们的兄弟姐妹和父母的健康状况和成本。最后，通过图表审查和其他健康计划数据，我们确定是否儿童家庭成员的AODD成人不太可能得到最佳的预防保健，或更有可能有记录表明家庭，法律的，或学校的问题比儿童在比较家庭。该研究对关键问题具有重要意义，例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服务的一部分进行治疗，以及卫生政策（包括高价值医疗保健服务列表中的AODD福利，低成本分摊）。

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).