Improving Care Continuity in Drug Abuse Treatment

在任何治疗系统中，住院治疗是最可取的治疗方式之一。然而，它也是最昂贵的之一，如果不能可靠地在门诊项目中继续进行后续护理，它的好处是有限的。这项服务研究项目将检验三种循证干预措施的比较有效性，以提高从住院治疗到门诊护理的成功过渡的历史最低比率。该项目在巴尔的摩市的治疗服务提供系统内进行，是约翰霍普金斯大学SOM、国家药物滥用治疗临床试验网络(CTN)的大西洋中部节点和巴尔的摩物质滥用系统(BSAS)(巴尔的摩市物质滥用管理局)之间的合作。将被审查的干预措施包括a)交通护送，在出院当天将住宿客户送到门诊转诊计划的门口；b)客户过渡激励，向成功登记门诊善后护理的客户提供财务激励；以及c)安排的Resident In-Reach。由门诊工作人员访问住宿计划中的转诊客户进行迎新访问。这些强化干预措施将与通常的护理控制条件进行比较，在这种情况下没有特殊干预措施。使用拉丁方交叉设计，最大限度地提高外部有效性，治疗条件将在两年项目期间以预定的顺序在6周的间隔时间内到位。主要结果衡量标准将是转诊客户在住院出院后30天内进入门诊善后护理计划的百分比。门诊住院时间的长短也将作为过渡干预的次要结果进行检查。总体而言，该项目将提供有价值的新数据，供政策制定者用来选择治疗过渡选项，使药物滥用治疗服务提供系统内的护理连续性最大化。

Residential treatment is one of the most desirable modalities offered in any treatment system. Yet it is also one of the most costly, and its benefits are limited if not followed reliably by continuing aftercare in an outpatient program. This services research project will examine the comparative effectiveness of three evidence-based interventions for improving historically low rates of successful transition from residential to outpatient care. The project takes place within the treatment service delivery system of Baltimore City and represents a collaboration between Johns Hopkins University SOM, the Mid Atlantic Node of the National Drug Abuse Treatment Clinical Trials Network (CTN) and Baltimore Substance Abuse Systems (BSAS), the Substance abuse authority for the City of Baltimore. The interventions to be examined are a) Transportation Escort that delivers residential clients to the door of the outpatient referral program on the day of discharge, b) Client Transition Incentive that offers a financial incentive to clients who successfully enroll in outpatient aftercare and c) Residential In-reach that arranges. orientation visits by outpatient staff who visit referral clients at the residential program. These enhanced interventions will be compared with a usual care control condition in which no special intervention is in place. Using a Latin Square cross-over design than maximizes external validity, treatment conditions will be in place during 6-week intervals of time in a pre-determined sequence during the 2-year project. Primary outcome measure will be the percent of referred clients who are admitted to an outpatient aftercare program within 30 days of residential discharge. Length of stay in the outpatient program will also be examined as a function of transition interventions as a secondary outcome. Overall, the project will provide valuable new data that can be used by policy makers to select treatment transition options that will maximize continuity of care within a drug abuse treatment services delivery system.