Substance Abuse Treatment Systems: An Interorganizational Network Perspective

描述（由申请人提供）：在药物滥用治疗领域，“护理的连续性”是指接受多层次的护理或治疗方式，从住院或住院到门诊和持续监测（McKay，2009）。护理连续性框架中隐含的是治疗提供者之间存在组织间关系。药物滥用治疗文献中提到的“护理系统”假定这种“系统”协调良好。然而，对治疗系统的描述却表明了相反的情况。治疗系统是分散的，几乎没有跨模式的协调（McLellan等人，2005; Saitz等人，2008年）。在从排毒出院时，患者复发的风险很高，因此容易受到系统故障的影响。为了改善对弱势群体的护理系统，我们需要首先检查其结构和有效性（Morrissey，Johnsen和Calloway，1996）。拟议的研究和培训计划包括数据管理，网络分析和多层次分析方面的技能发展。拟议的研究是第一个从组织间网络的角度研究药物滥用治疗系统。本申请中提出的研究是一个跨部门的，分析性的研究，在县物质滥用治疗系统和重新入院戒毒组织间网络之间的关系。社会网络分析将用于衡量服务提供者之间的联系。网络数据是患者在出院后14天内从一个提供者转移到另一个提供者。社会网络分析是一种创新的研究策略，可以提供重要的见解药物滥用治疗护理系统的服务协调。社会网络分析与卫生服务领域的相关性在最近的NIH社交网络与健康项目公告（PAR-10-146）中得到了证明。由于排毒服务的高成本和与持续的物质滥用相关的健康风险，重新接受排毒是物质滥用治疗系统的重要性能指标（McLellan等人，2005年）。这项研究的重点是加州的47个县，这些县在2008-2009年向该州报告了排毒入院数据。观察患者从一系列入院和出院到治疗提供者的路径，能够评估提供者之间的联系。该研究使用多水平分析来预测患者再入院排毒（N= 24，713）。该项目将分析来自两个管理数据库的数据：来自加州结局测量系统（CalOMS）的治疗事件数据，以及来自国家药物滥用治疗服务调查（N-SSATS）的机构级数据。组织间网络在成瘾健康服务研究领域很少受到关注。拟议的研究填补了这一空白，并为药物滥用治疗领域带来了更广阔的生态视角。 公共卫生相关性：拟议的研究和培训计划是第一个从组织间网络的角度研究药物滥用治疗系统。本申请中提出的研究是一个跨部门的，分析性的研究，在县物质滥用治疗系统和重新入院戒毒组织间网络之间的关系。来自加州结果测量系统（CalOMS）的档案数据将用于绘制药物滥用治疗提供者之间的联系图，并测量提供者网络内的服务整合。

DESCRIPTION (provided by applicant): In the field of substance abuse treatment, "continuity of care" refers to the receipt of multiple levels of care or treatment modalities, which range from inpatient or residential to outpatient and ongoing monitoring (McKay, 2009). Implicit in the continuity of care framework is the existence of interorganizational relationships among treatment providers. References to "systems of care" in the substance abuse treatment literature assume such "systems" are well-coordinated. Descriptions of the treatment system, however, suggest the opposite. Treatment systems are fragmented, with little coordination across modalities (McLellan et al., 2005; Saitz et al., 2008). At the point of discharge from detox, patients are at high risk of relapse and, therefore, vulnerable to system failures. To improve systems of care for vulnerable populations, we need to first examine their structure and effectiveness (Morrissey, Johnsen, & Calloway, 1996). The proposed research and training program includes skills development in data management, network analysis, and multi-level analysis. The proposed study is among the first to study substance abuse treatment systems from an interorganizational network perspective. The study proposed in this application is a cross-sectional, analytical study of the relationship between interorganizational networks in county substance abuse treatment systems and readmissions to detox. Social network analysis will be used to measure connectedness among service providers. The network data are patient transfers from one provider to another provider within 14 days of discharge. Social network analysis is an innovative research strategy that can provide important insights into services coordination in substance abuse treatment systems of care. The relevance of social network analysis to the health services field is evidenced by the recent NIH Program Announcement on Social Networks and Health (PAR-10-146). Because of the high cost of detox services and health risks associated with continued substance abuse, readmission to detox is an important performance measure for substance abuse treatment systems (McLellan et al., 2005). The study focuses on 47 counties in California that reported detox admission data to the state in 2008-2009. Observing the pathways of patients from series of admissions and discharges to and from treatment providers enables assessing connections among providers. The study uses multi-level analysis to predict patient readmission to detox (N=24,713). The project will analyze data from two from administrative databases: treatment episode data from the California Outcomes Measurement System (CalOMS), and facility-level data from the National Survey of Substance Abuse Treatment Services (N- SSATS). Interorganizational networks have enjoyed very little attention in the addiction health services research field. The proposed research fills this gap and brings a broader ecological perspective to the substance abuse treatment field. PUBLIC HEALTH RELEVANCE: The proposed research and training program is among the first to study substance abuse treatment systems from an interorganizational network perspective. The study proposed in this application is a cross-sectional, analytical study of the relationship between interorganizational networks in county substance abuse treatment systems and readmissions to detox. Archival data from the California Outcome Measurement System (CalOMS) will be used to map linkages among substance abuse treatment providers and measure services integration within provider networks.