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，“护理的连续性”是指接受多种级别的护理或治疗方式，范围从住院或住院到门诊和持续监测（McKay，2009）。护理连续性框架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”假设此类“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。治疗系统支离破碎，各模式间缺乏协调（McLellan 等人，2005 年；Saitz 等人，2008 年）。在戒毒出院时，患者复发的风险很高，因此很容易出现系统故障。为了改善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开发。拟议的研究是首批从组织间网络角度研究药物滥用治疗系统的研究之一。本申请中提出的研究是一项横断面分析研究，研究县药物滥用治疗系统中的组织间网络与重新戒毒之间的关系。社交网络分析将用于衡量服务提供商之间的联系。网络数据是患者出院 14 天内从一个提供者转移到另一提供者的数据。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护理系统中的服务协调提供重要见解。最近的 NIH 社交网络与健康计划公告 (PAR-10-146) 证明了社交网络分析与健康服务领域的相关性。由于戒毒服务的成本高昂以及与持续药物滥用相关的健康风险，重新接受戒毒是药物滥用治疗系统的一项重要绩效衡量标准（McLellan 等，2005）。该研究重点关注加州 47 个县，这些县在 2008 年至 2009 年向该州报告了戒毒入院数据。通过观察患者一系列入院和出院与治疗提供者之间的路径，可以评估提供者之间的联系。该研究使用多层次分析来预测患者再次入院戒毒 (N=24,713)。该项目将分析来自两个行政数据库的数据：来自加州结果测量系统 (CalOMS) 的治疗事件数据和来自全国药物滥用治疗服务调查 (N-SSATS) 的设施级数据。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泛的生态视角。公共卫生相关性：拟议的研究和培训计划是首批从组织间网络角度研究药物滥用治疗系统的计划之一。本申请中提出的研究是一项横断面分析研究，研究县药物滥用治疗系统中的组织间网络与重新入院戒毒之间的关系。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，并衡量提供者网络内的服务整合。