Life-course and cost trajectories of alcohol patients: a 15-year study

描述(由申请人提供)：这项竞争性延续申请回应了PA 06-258，“酒精使用障碍：治疗、服务研究和恢复”，并扩展了对1,204名管理性护理化学依赖(CD)患者的纵向研究。这项拟议的研究遵循终身发展的方法来了解酒精问题和康复，并与NIAAA五年战略计划的研究重点高度相关。最初的研究是一项随机试验，比较了日间医院和门诊患者在临床疗效、医疗利用和成本方面的差异，包括基线、6个月和12个月以及5、7、9和11年的访谈，以及连续的自动化利用和成本数据。我们建议在13年和15年跟踪样本。随着时间的推移，我们观察到的变化是非线性的。这些额外的后续行动对于使用易于研究变化的建模技术，如潜在阶级增长分析和潜在曲线增长模型，实现对酒精和药物随时间的轨迹的稳定估计至关重要。我们研究：1)随着个人从一个生命阶段进入另一个生命阶段的康复过程，2)包括CD治疗、医疗和精神服务的健康计划持续护理方法，3)死亡率和医疗和精神问题，4)酒精和药物轨迹与生命过程事件的关系，因为它们影响利用率和成本，以及5)医疗保健差异如何影响结果。 我们还对60名参与者进行了定性访谈，这些参与者按性别和缓解程度代表了生命阶段的不同阶段。我们使用一种发展/生命历程的观点，与一个概念框架相结合，该框架包括：个人、治疗和额外治疗特征。我们将检查我们的样本，因为他们在15岁时从基线的一个年龄组转移到另一个年龄组(例如，我们最年轻的年龄组(基线年龄为18-29岁)将是33-44岁)。这使我们能够研究与每个生命阶段相关的问题，以更好地了解成熟和其他生命过程的影响，以及它们与酒精和药物使用、医疗问题、死亡率和服务使用的相互作用。这项研究对制定针对长期康复的持续护理方法具有重要意义。

DESCRIPTION (provided by applicant): This competing continuation application responds to PA 06-258, "Alcohol Use Disorders: Treatment, Services Research and Recovery," and extends a longitudinal study of 1,204 managed care Chemical Dependency (CD) patients. The proposed study follows a life span developmental approach to understanding alcohol problems and recovery and is highly relevant to the research priorities of the NIAAA 5- year strategic plan. The original study was a randomized trial comparing day hospital to outpatient patients on clinical effectiveness and medical utilization and costs, and included interviews at baseline, 6 and 12 months, and 5, 7, 9, and 11 years, and continuous automated utilization and cost data. We propose to follow the sample at 13 and 15 years. Changes we have observed overtime have been non-linear. These additional follow-ups are essential to achieve stable estimates of alcohol and drug trajectories over time, using modeling techniques that are amenable to study change such as latent class growth analyses and latent curve growth models. We examine: 1) the course of recovery as individuals move from one life stage to another, 2) a health plan continuing care approach that includes CD treatment, medical and psychiatric services, 3) mortality and medical and psychiatric problems, 4) alcohol and drug trajectories in relationship to life course events as they affect utilization and cost, and 5) how health care disparities affect outcomes. We also conduct qualitative interviews with a sub-sample of 60 participants who represent strata of life stages by gender and remission. We use a developmental/life-course perspective integrated with a conceptual framework comprising domains of: individual, treatment, and extra-treatment characteristics. We will examine our sample as they move from one age group at baseline to another at 15-year (e.g., our youngest age group (aged 18-29 at baseline) will be 33-44). This allows us to examine questions pertinent to each life phase, for a better understanding of maturation and other life course effects and their interaction with alcohol and drug use, medical problems, mortality and service use. The study has important implications for developing a continuing care approach addressing long-term recovery.