EXTENDED CASE MONITORING FOR ALCOHOLICS--HEALTH COSTS

这一研究的根本目标是找到方法来 管理酒精问题患者的治疗，这些问题会导致 以尽可能低的成本为患者提供尽可能好的长期结果 向社会致敬。我们认为，从一个角度评估酒精治疗是至关重要的 长期观点，因为酗酒是一种反复发作的障碍， 社会、健康和经济影响往往被推迟。临床 对饮酒结果衡量产生短期影响的策略 可能会也可能不会对以下结果衡量标准产生实质性的长期影响 作为医疗保健或其他具有重大社会利益的费用。在……里面 本项目，我们将研究一个跟踪方案的有效性 监测和转介临床结果和长期保健 在卫生保健组织登记的酒精患者的使用情况。患者将被随机分配 扩大病例监测与标准治疗的对比。推广的情况 监控计划旨在增强现有的有效性 上瘾治疗服务，而不是取代他们。这项干预将 帮助确保患者与医疗保健系统保持联系 在治疗后的一段时间内，复发的风险 特别高，也是在较低的强度下，用于后续 复发风险仍然较高的两年期间。这个 病例监测和转诊干预旨在实现低成本 可由只需最少临床培训的人员提供的方案 因此，每个患者每年的成本很低。这个案例监控着谁交付了 干预本身不会做任何治疗，而是评估 并酌情将病人转介至现有的治疗服务。这个 干预设计的基本原理是基于使用的协议 在其他心理健康领域取得成功，之前对成瘾的研究， 关于社会支持的文献，以及复发的模型。这是一种主动的 与病人及其家属保持联系的制度是 旨在弥补目前提供治疗的系统中的缺陷 对酗酒者，向患者提供治疗服务 基于他们在紧急危机时刻的需求，而不是他们的 实际需求水平。在目前的递送系统下，许多患者 可能从临床干预中受益，但在他们的 局势已大幅恶化。较早重新接受治疗 应该提高平均结局水平，并从长远来看降低健康 通过最大限度地减少要处理的高级别护理的需求来降低护理成本 严重的危机。

The fundamental goal of this line of research is to find approaches to managing the treatment of patients with alcohol problems that produce the best possible long-term outcomes for patients at the lowest possible cost to society. We feel it is critical to evaluate alcohol treatments from a long-term perspective since alcoholism is a recurrent disorder whose social, health, and economic effects are often delayed. Clinical strategies that produce short-term effects on drinking outcome measures may or may not have substantial long-term impact on outcome measures such as health care or other costs which are of substantial social interest. In this project, we will study the effectiveness of a program of followup monitoring and referral on the clinical outcome and long-term health care use of alcohol patients enrolled in an HMO. Patients will be randomized into extended case monitoring vs. standard treatment. The extended case monitoring program is designed to augment the effectiveness of existing addictions treatment services, not to replace them. The intervention will help ensure that patients stay in contact with the health care system during a period immediately after treatment when the risk of relapse is especially high, and also, at a lower level of intensity, for a followup period of two years during which risk of relapse remains elevated. The case monitoring and referral intervention is designed to be a low-cost protocol that can be delivered by personnel with minimal clinical training and therefore low cost per patient per year. The Case Monitors who deliver the intervention will not themselves do any treatment, but rather assess and refer patients, where appropriate, to existing treatment services. The rationale for the intervention design is based upon protocols used successfully in other mental health fields, prior research in addictions, the literature on social support, and models for relapse. This proactive system for maintaining contact with patients and their families is intended to remedy a defect in the present system of delivering treatment to alcohol abusers, in which treatment services are provided to patients on the basis of their demand at points of acute crisis rather than their actual level of need. Under the current delivery system, many patients who could benefit from clinical intervention fail to seek services until their situation has deteriorated substantially. Earlier re-entry into treatment should improve average outcome levels and over the long run reduce health care costs by minimizing the need for high levels of care to deal with severe crises.