Substance Abuse Treatment Systems: An Interorganizational Network Perspective

药物滥用治疗系统：组织间网络视角

基本信息

批准号：
8126957
负责人：
Suzanne Evelyn Spear
金额：
$ 3.41万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-07-01 至 2012-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8126957
关键词：
Achievement Address Admission activity Applications Grants Attention Back Behavioral California Caring Chromosome Mapping Client Collaborations Communities Continuity of Patient Care County Data Data Analyses Development Drug Metabolic Detoxication Effectiveness Elements Failure Fostering Foundations Future Goals Health Health Personnel Health Service Area Health Services Health Services Research Inpatients Intervention Joints Knowledge Link Literature Measurement Measures Mental Health Modality Monitor NIH Program Announcements Outcome Outpatients Pathway Analysis Pathway interactions Patient Readmission Patient Transfer Patients Performance Primary Health Care Provider Public Health Recycling Rehabilitation therapy Relapse Reporting Research Research Personnel Research Training Resources Risk Series Services Social Network Structure Substance abuse problem Surveys System Testing Time Training Programs Variant Vulnerable Populations addiction administrative database care systems career cohesion cost data management density high risk improved innovation insight interest patient population professor programs psychosocial skills substance abuse treatment

项目摘要

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.

描述（由申请人提供）：在药物滥用治疗领域，“护理连续性”是指收到多个护理或治疗方式，范围从住院或住院到门诊和持续的监测（McKay，2009年）。在护理框架的连续性中隐含的是治疗提供者之间的组织间关系。在药物滥用治疗文献中对“护理系统”的引用假定这种“系统”是良好的协调。但是，治疗系统的描述表明相反。治疗系统是分散的，几乎没有跨模态的协调（McLellan等，2005； Saitz等，2008）。在排毒的解释点，患者的复发风险很高，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年）。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开发。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的研究。该应用中提出的研究是对县药物滥用治疗系统中的组织间网络与排毒再选中的组织间网络之间关系的横断面分析研究。社交网络分析将用于衡量服务提供商之间的联系。网络数据是在出院后14天内从一个提供商转移到另一个提供商的患者转移。社交网络分析是一种创新的研究策略，可以为药物滥用治疗系统的服务协调提供重要的见解。最近在社交网络和卫生方面的公告（PAR-10-146）证明了社交网络分析与卫生服务领域的相关性。由于排毒服务的高成本和与持续滥用药物有关的健康风险，因此排毒是对药物滥用治疗系统的重要绩效措施（McLellan等，2005）。该研究重点是加利福尼亚州的47个县，这些县在2008 - 2009年向该州报告了排毒的入院数据。观察从一系列入院和出院的患者途径与治疗提供者的途径可以评估提供者之间的联系。该研究使用多级分析来预测患者的排毒（n = 24,713）。该项目将分析来自行政数据库的两个数据的数据：来自加利福尼亚州成果测量系统（CALOM）的治疗事件数据，以及来自国家药物滥用治疗服务（N- SSATS）的设施级数据。组织间网络在成瘾健康服务研究领域的关注很少。拟议的研究填补了这一空白，并为滥用药物治疗领域带来了更广泛的生态观点。公共卫生相关性：拟议的研究与培训计划是最早从组织间网络的角度研究药物滥用治疗系统的计划之一。该应用中提出的研究是对县药物滥用治疗系统中的组织间网络与排毒再选中的组织间网络之间关系的横断面分析研究。加利福尼亚州结果测量系统（CALOM）的档案数据将用于绘制滥用药物治疗提供者之间的联系，并衡量提供商网络中的服务集成。