Disease Management for Chronic Drug Abuse

慢性药物滥用的疾病管理

• 批准号: 8134739
• 负责人: JON MORGENSTERN
• 金额: $ 15万
• 依托单位: PARTNERSHIP TO END ADDICTION
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8134739
• 关键词: Accident and Emergency department; Aftercare; Alcoholism; Caring; Case Management; Centers for Disease Control and Prevention (U.S.); Characteristics; Chronic; Chronic Disease; Client; Counseling; County; Criminal Justice; Data; Disease; Disease Management; Drug Metabolic Detoxication; Drug abuse; Effectiveness; Encapsulated; Enrollment; Evaluation; Event; Expenditure; Funding; Grant; Guidelines; Health Care Costs; Healthcare; Hospitalization; Human immunodeficiency virus test; Individual; Inpatients; Intervention; Length of Stay; Medicaid; Medical; Methods; Monitor; New York; Outcome; Outpatients; Performance; Pharmaceutical Preparations; Randomized; Records; Refractory; Rehabilitation therapy; Relative (related person); Research; Research Personnel; Services; State Government; Substance abuse problem; System; Testing; Time; Visit; addiction; alcohol and other drug; chronic care model; cost; design; high risk; improved; innovation; primary outcome; programs; response; treatment as usual

DESCRIPTION (provided by applicant): Individuals with long-standing, treatment refractory alcohol and other drug (AOD) disorders remain a vexing challenge for State governments. As with other chronic diseases, a small proportion of clients absorb a disproportionate share of treatment dollars. Often these clients cycle through crisis episodes with bouts of high-cost care followed by poorly coordinated aftercare. As the primary payers, state and county agencies not only are concerned with inefficient spending for AOD treatment (TX) but also must contend with supporting multiple crisis services for these individuals. Recently states have been turning to disease management programs (DMP) to control Medicaid costs of caring for chronic illnesses. Despite their promise, there is only modest scientific evidence of the effectiveness of DMPs for healthcare, and none for AOD disorders. New York State (NYS) just initiated a 3-year, $25 million demonstration pilot that provides grants to 23 counties to provide case management services to high-cost utilizers of AODTX. This time sensitive R01 application in response to PAR-05-150 seeks to capitalize on this demonstration to mount and rigorously test an innovative disease management intervention for chronic addiction (DM-CA). The application is time-sensitive because the intervention and evaluation must be funded by summer of 2007 to take advantage of the demonstration. The NYS Office of Alcoholism and Substance Abuse Services (OASAS) and two counties will partner with our research group to develop and rigorously test DM-CA. The DM-CA will be a system level intervention with a framework drawn from recent innovations in health care encapsulated in the Chronic Care Model. DM-CA will be designed to improve monitoring and coordination of care in order to avert crisis events (e.g., ED visits) and help engage clients in stabilizing outpatient services, thereby reducing health care costs. Over two years, OASAS will identify 1,700 high cost AOD disordered clients (i.e., using >=$10k of AODTX in the prior year) and then randomly assign them within county to DM- CA or a control condition of usual care (UC), consisting of no case management or DMP services. Client characteristics and outcomes will be collected from extensive administrative records. Primary Aims will examine 1) reductions in crises events, 2) increases in number of outpatient AODTX, 3) increases in likelihood of HIV/HCV testing & counseling, 4) Medicaid cost reductions associated with the intervention.

描述（由申请人提供）：长期以来，治疗难治性酒精和其他药物（AOD）疾病的人仍然对州政府来说是一个烦人的挑战。与其他慢性疾病一样，一小部分客户吸收了不成比例的治疗费用。这些客户通常会在危机情节中循环，并进行了高成本的护理，然后是协调不足的后期护理。作为主要付款人，州和县机构不仅关注AOD治疗效率低下的支出（TX），而且还必须与为这些人提供多个危机服务。最近，各州一直在转向疾病管理计划（DMP）来控制照顾慢性病的医疗补助成本。尽管他们承诺，但只有DMP对医疗保健的有效性，而没有针对AOD疾病的有效性。纽约州（NYS）刚刚发起了一名3年，2500万美元的示威飞行员，为23个县提供赠款，向AODTX的高成本利用者提供案例管理服务。这次对PAR-05-150的敏感R01应用程序旨在利用这一演示，以登上并严格测试慢性成瘾的创新疾病管理干预措施（DM-CA）。该应用是时间敏感的，因为必须在2007年夏季之前资助干预措施和评估，以利用示范。纽约州酒精中毒和药物滥用服务（OASA）和两个县将与我们的研究小组合作，并严格测试DM-CA。 DM-CA将是系统级干预，其框架是由慢性护理模型中封装的近期卫生保健创新所汲取的框架。 DM-CA将旨在改善对护理的监控和协调，以避免危机事件（例如，ED访问），并帮助客户稳定门诊服务，从而降低医疗保健费用。在两年的时间里，OASA将确定1,700个高成本AOD无序的客户（即上一年使用> = = $ = $ 10K的AODTX），然后将其随机分配给DM-CA或通常的CARE CARE（UC）（UC）（UC）（UC），不包括案例管理或DMP服务。客户特征和成果将从广泛的行政记录中收集。主要目的将检查1）减少危机事件，2）门诊AODTX的数量增加，3）HIV/HCV测试和咨询的可能性增加，4）与干预相关的医疗补助成本降低。