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Choi S, O’Grady MA, Cleland CM, Knopf E, Hong S, D’Aunno T, Bao Y, Ramsey KS, Neighbors CJ. Clinics Optimizing MEthadone Take-homes for opioid use disorder (COMET): Protocol for a stepped-wedge randomized trial to facilitate clinic level changes. PLoS One 2023; 18:e0286859. [PMID: 37294821 PMCID: PMC10256218 DOI: 10.1371/journal.pone.0286859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 06/11/2023] Open
Abstract
INTRODUCTION Regulatory changes made during the COVID-19 public health emergency (PHE) that relaxed criteria for take-home dosing (THD) of methadone offer an opportunity to improve quality of care with a lifesaving treatment. There is a pressing need for research to study the long-term effects of the new PHE THD rules and to test data-driven interventions to promote more effective adoption by opioid treatment programs (OTPs). We propose a two-phase project to develop and test a multidimensional intervention for OTPs that leverages information from large State administrative data. METHODS AND ANALYSIS We propose a two-phased project to develop then test a multidimensional OTP intervention to address clinical decision making, regulatory confusion, legal liability concerns, capacity for clinical practice change, and financial barriers to THD. The intervention will include OTP THD specific dashboards drawn from multiple State databases. The approach will be informed by the Health Equity Implementation Framework (HEIF). In phase 1, we will employ an explanatory sequential mixed methods design to combine analysis of large state administrative databases-Medicaid, treatment registry, THD reporting-with qualitative interviews to develop and refine the intervention. In phase 2, we will conduct a stepped-wedge trial over three years with 36 OTPs randomized to 6 cohorts of a six-month clinic-level intervention. The trial will test intervention effects on OTP-level implementation outcomes and patient outcomes (1) THD use; 2) retention in care; and 3) adverse healthcare events). We will specifically examine intervention effects for Black and Latinx clients. A concurrent triangulation mixed methods design will be used: quantitative and qualitative data collection will occur concurrently and results will be integrated after analysis of each. We will employ generalized linear mixed models (GLMMs) in the analysis of stepped-wedge trials. The primary outcome will be weekly or greater THD. The semi-structured interviews will be transcribed and analyzed with Dedoose to identify key facilitators, barriers, and experiences according to HEIF constructs using directed content analysis. DISCUSSION This multi-phase, embedded mixed methods project addresses a critical need to support long-term practice changes in methadone treatment for opioid use disorder following systemic changes emerging from the PHE-particularly for Black and Latinx individuals with opioid use disorder. By combining findings from analyses of large administrative data with lessons gleaned from qualitative interviews of OTPs that were flexible with THD and those that were not, we will build and test the intervention to coach clinics to increase flexibility with THD. The findings will inform policy at the local and national level.
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Affiliation(s)
- Sugy Choi
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Megan A. O’Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, United States of America
| | - Charles M. Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Elizabeth Knopf
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
| | - Sueun Hong
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
- New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Thomas D’Aunno
- New York University Wagner School of Public Policy, New York, NY, United States of America
| | - Yuhua Bao
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States of America
| | - Kelly S. Ramsey
- New York State Office of Addiction Services and Supports (OASAS), New York, NY, United States of America
| | - Charles J. Neighbors
- Department of Population Health, New York University Grossman School of Medicine, New York City, NY, United States of America
- New York University Wagner School of Public Policy, New York, NY, United States of America
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Ellis JD, Rabinowitz JA, Ware OD, Wells J, Dunn KE, Huhn AS. Patterns of polysubstance use and clinical comorbidity among persons seeking substance use treatment: An observational study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208932. [PMID: 36880895 PMCID: PMC10035066 DOI: 10.1016/j.josat.2022.208932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/08/2022] [Accepted: 10/31/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Polysubstance use is common among individuals seeking treatment for substance use disorders (SUD). However, we know less about patterns and correlates of polysubstance use among treatment-seeking populations. The current study aimed to identify latent patterns of polysubstance use and associated risk factors in persons entering SUD treatment. METHODS Patients (N = 28,526) being admitted for substance use treatment reported on their use of thirteen substances (e.g., alcohol, cannabis, cocaine, amphetamines, methamphetamines, other stimulants, heroin, other opioids, benzodiazepines, inhalants, synthetics, hallucinogens, and club drugs) in the month before treatment and prior to the month before treatment. Latent class analysis (LCA) determined the relationship between class membership and gender, age, employment status, unstable housing, self-harm, overdose, past treatment, depression, generalized anxiety disorder, and/or post-traumatic stress disorder (PTSD). RESULTS Identified classes included: 1) Alcohol primary, 2) Moderate probability of past-month alcohol, cannabis, and/or opioid use; 3) Alcohol primary, Lifetime cannabis and cocaine use; 4) Opioid primary, Lifetime use of alcohol, cannabis, hallucinogens, club drugs, amphetamines, and cocaine; 5) Moderate probability of past-month alcohol, cannabis, and/or opioid use, Lifetime use of various substances; 6) Alcohol and cannabis primary, Lifetime use of various substances; and 7) High past-month polysubstance use. Individuals who engaged in past-month polysubstance use attended to face elevated risk of screening positive for recent unstable housing, unemployment, depression, anxiety, PTSD, self-harm, and overdose. CONCLUSIONS Current polysubstance use is associated with significant clinical complexity. Tailored treatments that reduce harms resulting from polysubstance use and related psychiatric comorbidity may improve treatment outcomes in this population.
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Affiliation(s)
- Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Jill A Rabinowitz
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Orrin D Ware
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America; University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, NC, United States of America
| | - Jonathan Wells
- Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Kelly E Dunn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Andrew S Huhn
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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Guerrero EG, Amaro H, Kong Y, Khachikian T, Marsh JC. Understanding the role of financial capacity in the delivery of opioid use disorder treatment. BMC Health Serv Res 2023; 23:166. [PMID: 36797752 PMCID: PMC9933309 DOI: 10.1186/s12913-023-09179-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Opioid treatment programs must have adequate financial capacity to sustain operations and deliver a high standard of care for individuals suffering from opioid use disorder. However, there is limited consistency in the health services literature about the concept and relationship of organizational financial capacity and key outcome measures (wait time and retention). In this study, we explored five common measures of financial capacity that can be applied to opioid treatment programs: (a) reserve ratio, (b) equity ratio, (c) markup, (d) revenue growth, and (e) earned revenue. We used these measures to compare financial capacity among 135 opioid treatment programs across four data collection points: 2011 (66 programs), 2013 (77 programs), 2015 (75 programs), and 2017 (69 programs). We examined the relationship between financial capacity and wait time and retention. Findings from the literature review show inconsistencies in the definition and application of concepts associated with financial capacity across business and social service delivery fields. The analysis shows significant differences in components of financial capacity across years. We observed an increase in average earned revenue and markup in 2017 compared to prior years. The interaction between minorities and markup was significantly associated with higher likelihood of waiting (IRR = 1.077, p < .05). Earned revenue (IRR = 0.225, p < .05) was related to shorter wait time in treatment. The interaction between minorities and equity ratio is also significantly associated with retention (IRR = 0.796, p < .05). Our study offers a baseline view of the role of financial capacity in opioid treatment and suggests a framework to determine its effect on client-centered outcomes.
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Affiliation(s)
- Erick G. Guerrero
- Research to End Health Disparities Corp, I-Lead Institute, 12300 Wilshire Blvd., Suite 210, Los Angeles, CA 90025 USA
| | - Hortensia Amaro
- grid.65456.340000 0001 2110 1845Herbert Werthein College of Medicine and Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8Th St., AHC4, Miami, FL 33199 USA
| | - Yinfei Kong
- grid.253559.d0000 0001 2292 8158College of Business and Economics, California State University Fullerton, 800 N. State College Blvd., Fullerton, CA 92831 USA
| | - Tenie Khachikian
- grid.170205.10000 0004 1936 7822Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60Th St., Chicago, IL 60637 USA
| | - Jeanne C. Marsh
- grid.170205.10000 0004 1936 7822Crown Family School of Social Work, Policy, and Practice, University of Chicago, 969 E. 60Th St., Chicago, IL 60637 USA
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Auty SG, Cole MB, Wallace J. Association Between Medicaid Managed Care Coverage of Substance Use Services and Treatment Utilization. JAMA HEALTH FORUM 2022; 3:e222812. [PMID: 36218990 PMCID: PMC9419018 DOI: 10.1001/jamahealthforum.2022.2812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/03/2022] [Indexed: 11/22/2022] Open
Abstract
Importance Medicaid insures a disproportionate share of adults with substance use disorder (SUD) and is thus uniquely positioned to facilitate access to care. Many enrollees receive coverage through Medicaid managed care (MMC) plans, which receive capitated payments in exchange for coverage of a defined set of benefits. Historically, coverage of substance use services has been carved out of MMC plans and financed fee-for-service (FFS) by state Medicaid programs, but in recent years, many states have opted to carve in this benefit. Little is known about whether MMC coverage of substance use services, relative to FFS coverage, is associated with changes in utilization. Objective To examine the association between changes in MMC coverage of substance use services and admissions for substance use treatment. Design, Setting, and Participants This cross-sectional study examined changes in admissions for substance use treatment in 2 states after coverage of substance use services was either carved into (Nebraska) or carved out of (Maryland) comprehensive MMC coverage. Synthetic control methods were used to compare changes in admissions between states that did and did not alter MMC coverage of substance use services. Data on substance use treatment admissions were obtained from the Treatment Episode Data Set-Admissions from 2010 to 2019. Exposures Carve-outs or carve-ins of coverage for both inpatient and outpatient substance use services from comprehensive MMC coverage. Main Outcomes and Measures Reported substance use treatment admissions per 100 000 residents and admissions by treatment type (ie, rehabilitation or residential, outpatient, and detoxification) per 100 000 residents. Results Maryland's carve-out was associated with an additional mean 787.1 (95% CI, 624.6-1141.7) substance use admissions per 100 000 residents during 2015 and 2016, a relative increase of 104.4% (95% CI, 64.4%-154.1%) compared with its synthetic control. This increase was concentrated among changes in outpatient services utilization. In Nebraska, the carve-in was associated with a mean decrease of 97.2 (95% CI, -23.4 to 213.6) admissions per 100 000 residents, a relative decrease of 33.2% (95% CI, -54.1% to 29.6%) compared with its synthetic control and was concentrated primarily among admissions for detoxification services. Conclusions and Relevance The results of this cross-sectional study suggest that carving out coverage of substance use services and financing them through FFS coverage may be associated with overall increases in treatment utilization but with heterogeneous associations across states and treatment types.
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Affiliation(s)
- Samantha G. Auty
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Megan B. Cole
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Jacob Wallace
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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Neighbors CJ, Yerneni R, Sun Y, Choi S, Burke C, O’Grady MA, McDonald R, Morgenstern J. Effects of a New York Medicaid Care Management Program on Substance Use Disorder Treatment Services and Medicaid Spending: Implications for Defining the Target Population. Subst Abuse 2022; 16:11782218221075041. [PMID: 35125871 PMCID: PMC8808013 DOI: 10.1177/11782218221075041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 01/05/2022] [Indexed: 06/14/2023]
Abstract
AIMS We examined the effects of a statewide New York (NY) care management (CM) program for substance use disorder (SUD), Managed Addiction Treatment Services (MATS), on SUD treatment services' utilization and spending among patients with a recent history of high Medicaid spending and among those for whom a predictive algorithm indicates a higher probability of outlier spending in the following year. METHODS We applied difference-in-difference analyses with propensity score matching using NY Medicaid claims data and a state registry of SUD-treatment episodes from 2006 to 2009. A total of 1263 CM enrollees with high SUD treatment spending (>$10K) in the prior year and a matched comparison group were included in the analysis. Crisis care utilization for SUD (detoxification and hospitalizations), outpatient SUD treatment, and Medicaid spending were examined over 12 months among both groups. CM effects among predicted high-future-spending patients (HFS) were also analyzed. RESULTS CM increased outpatient SUD treatment visits by approximately 10.5 days (95% CI = 0.9, 20.0). CM crisis care and spending outcomes were not statistically different from comparison since both conditions had comparable pre-post declines. Conversely, CM significantly reduced SUD treatment spending by approximately $955 (95% CI = -1518, -391) and reduced days of detox utilization by about 1.0 days (95% CI = -1.9, -0.1) among HFS. CONCLUSION Findings suggest that CM can reduce SUD treatment spending and utilization when targeted at patients with a greater likelihood of high future spending, indicating the potential value of predictive models to select CM patients.
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Affiliation(s)
- Charles J Neighbors
- Center on Addiction, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | | | - Yi Sun
- New York State Office of Alcoholism and Substance Abuse Services, Albany, NY, USA
| | - Sugy Choi
- Center on Addiction, New York, NY, USA
- New York University Grossman School of Medicine, New York, NY, USA
| | - Constance Burke
- New York State Office of Alcoholism and Substance Abuse Services, Albany, NY, USA
| | | | - Rebecca McDonald
- Center on Addiction, New York, NY, USA
- King’s College London, London, UK
| | - Jon Morgenstern
- Center on Addiction, New York, NY, USA
- Northwell Health, New Hyde Park, NY, USA
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Peacock-Chambers E, Schiff DM, Zuckerman B. Caring for Families with Young Children Affected by Substance Use Disorder: Needed Changes. J Dev Behav Pediatr 2021; 42:408-410. [PMID: 33883526 PMCID: PMC8192421 DOI: 10.1097/dbp.0000000000000942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/15/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth Peacock-Chambers
- Department of Pediatrics, University of Massachusetts Medical School-Baystate
- Institute for Healthcare Delivery and Population Science, Springfield, MA
| | - Davida M. Schiff
- Division of General Academic Pediatrics, Mass General Hospital for Children, Boston, MA
| | - Barry Zuckerman
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
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Abstract
Alcohol use disorder (AUD) and family functioning are inextricably bound, and families are impacted negatively by AUD, but families show substantial improvements with AUD recovery. Family members can successfully motivate a person with AUD to initiate changes in drinking or to seek AUD treatment. During recovery, family members can provide active support for recovery. Several couple- or family-involved treatments for AUD have been developed and tested in rigorous efficacy trials. Efficacious treatments based in family systems theory or cognitive behavioral approaches focus on the concerned family member alone, or they engage the couple or family as a unit in the treatment. However, most treatments have been studied in fairly homogeneous, heterosexual, White, non-Hispanic populations, limiting the potential generalizability of these treatments. Substantial gaps remain in our understanding of family processes associated with the initiation and maintenance of AUD recovery among adults. This review outlines the existing literature and describes opportunities for future research to address knowledge gaps in understanding the mechanisms by which these treatments are efficacious, use of family-based treatments with diverse populations, integration of pharmacotherapies with family-involved treatment, role of families in recovery-oriented systems of care, and how to improve treatment development and dissemination.
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Affiliation(s)
- Barbara S. McCrady
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, New Mexico
| | - Julianne C. Flanagan
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
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O'Grady MA, Lincourt P, Greenfield B, Manseau MW, Hussain S, Genece KG, Neighbors CJ. A facilitation model for implementing quality improvement practices to enhance outpatient substance use disorder treatment outcomes: a stepped-wedge randomized controlled trial study protocol. Implement Sci 2021; 16:5. [PMID: 33413493 PMCID: PMC7789887 DOI: 10.1186/s13012-020-01076-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/13/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The misuse of and addiction to opioids is a national crisis that affects public health as well as social and economic welfare. There is an urgent need for strategies to improve opioid use disorder treatment quality (e.g., 6-month retention). Substance use disorder treatment programs are challenged by limited resources and a workforce that does not have the requisite experience or education in quality improvement methods. The purpose of this study is to test a multicomponent clinic-level intervention designed to aid substance use disorder treatment clinics in implementing quality improvement processes to improve high-priority indicators of treatment quality for opioid use disorder. METHODS A stepped-wedge randomized controlled trial with 30 outpatient treatment clinics serving approximately 2000 clients with opioid use disorder each year will test whether a clinic-level measurement-driven, quality improvement intervention, called Coaching for Addiction Recovery Enhancement (CARE), improves (a) treatment process quality measures (use of medications for opioid use disorder, in-treatment symptom and therapeutic progress, treatment retention) and (b) recovery outcomes (substance use, health, and healthcare utilization). The CARE intervention will have the following components: (1) staff clinical training and tools, (2) quality improvement and change management training, (3) external facilitation to support implementation and sustainability of quality improvement processes, and (4) an electronic client-reported treatment progress tool to support data-driven decision making and clinic-level quality measurement. The study will utilize multiple sources of data to test study aims, including state administrative data, client-reported survey and treatment progress data, and staff interview and survey data. DISCUSSION This study will provide the field with a strong test of a multicomponent intervention to improve providers' capacity to make systematic changes tied to quality metrics. The study will also result in training and materials that can be shared widely to increase quality improvement implementation and enhance clinical practice in the substance use disorder treatment system. TRIAL REGISTRATION Trial # NCT04632238NCT04632238 registered at clinicaltrials.gov on 17 November 2020.
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Affiliation(s)
- Megan A O'Grady
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave., Farmington, CT, 06030-2635, USA.
| | - Patricia Lincourt
- New York State Office of Addiction Services and Supports, 1450 Western Ave., Albany, NY, 12203, USA
| | - Belinda Greenfield
- New York State Office of Addiction Services and Supports, 501 7th Ave., 8th Floor, New York, NY, 10018, USA
| | - Marc W Manseau
- New York State Office of Addiction Services and Supports, 501 7th Ave., 8th Floor, New York, NY, 10018, USA
| | - Shazia Hussain
- New York State Office of Addiction Services and Supports, 1450 Western Ave., Albany, NY, 12203, USA
| | - Kamala Greene Genece
- Partnership to End Addiction, 485 Lexington Avenue, 3rd Floor, New York, NY, 10017-6706, USA
| | - Charles J Neighbors
- Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
- NYU Wagner Graduate School of Public Service, 295 Lafayette Street, New York, NY, 10012, USA
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Torres ME, Brolin M, Panas L, Ritter G, Hodgkin D, Lee M, Merrick E, Horgan C, Hopwood JC, Gewirtz A, De Marco N, Lane N. Evaluating the feasibility and impact of case rate payment for recovery support navigator services: a mixed methods study. BMC Health Serv Res 2020; 20:1004. [PMID: 33143701 PMCID: PMC7607694 DOI: 10.1186/s12913-020-05861-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 10/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background Acute 24-h detoxification services (detox) are necessary but insufficient for many individuals working towards long-term recovery from opiate, alcohol or other drug addiction. Longer engagement in substance use disorder (SUD) treatment can lead to better health outcomes and reductions in overall healthcare costs. Connecting individuals with post-detox SUD treatment and supportive services is a vital next step. Toward this end, the Massachusetts Medicaid program reimburses Community Support Program staff (CSPs) to facilitate these connections. CSP support services are typically paid on a units-of-service basis. As part of a larger study testing health care innovations, one large Medicaid insurer developed a new cadre of workers, called Recovery Support Navigators (RSNs). RSNs performed similar tasks to CSPs but received more extensive training and coaching and were paid an experimental case rate (a flat negotiated reimbursement). This sub-study evaluates the feasibility and impact of case rate payments for RSN services as compared to CSP services paid fee-for-service. Methods We analyzed claims data and RSN service data for a segment of the Massachusetts Medicaid population who had more than one detox admission in the last year and also engaged in post-discharge CSP or RSN services. Qualitative data from key informant interviews and Learning Collaboratives with CSPs and RSNs supplemented the findings. Results Clients receiving RSN services under the case rate utilized the service significantly longer than clients receiving CSP services under unit-based billing. This resulted in a lower average cost per member per month for RSN clients. However, when calculating total SUD treatment costs per member, RSN client costs were 50% higher than CSP client costs. Provider organizations employing RSNs successfully implemented case rate billing. Benefits included allowing time for outreach efforts and training and coaching, activities not paid under the unit-based system. Yet, RSNs identified staffing and larger systems level challenges to consider when using a case rate payment model. Conclusions Addiction is a chronic disease that requires long-term investments. Case rate billing offers a promising option for payers and providers as it promotes continued engagement with service providers. To fully realize the benefits of case rate billing, however, larger systems level changes are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05861-8.
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Affiliation(s)
- Maria E Torres
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA. .,Smith College School for Social Work, Lilly Hall, Northampton, MA, 01060, USA.
| | - Mary Brolin
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Lee Panas
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Grant Ritter
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Dominic Hodgkin
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Margaret Lee
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Elizabeth Merrick
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Constance Horgan
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
| | - Jonna C Hopwood
- Massachusetts Behavioral Health Partnership, a Beacon Health Options company, 1000 Washington Street, Suite 310, Boston, MA, 02118, USA
| | - Andrea Gewirtz
- Massachusetts Behavioral Health Partnership, a Beacon Health Options company, 1000 Washington Street, Suite 310, Boston, MA, 02118, USA
| | - Natasha De Marco
- Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Nancy Lane
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA, 02453, USA
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O'Grady MA, Lincourt P, Gilmer E, Kwan M, Burke C, Lisio C, Neighbors CJ. How are Substance Use Disorder Treatment Programs Adjusting to Value-Based Payment? A Statewide Qualitative Study. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2020; 14:1178221820924026. [PMID: 32518481 PMCID: PMC7252360 DOI: 10.1177/1178221820924026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 11/16/2022]
Abstract
Healthcare systems are implementing value-based payment (VBP) arrangements in efforts to incentivize cost-effective, high quality of care. These arrangements represent a major shift for substance use disorder (SUD) treatment providers who may need to make changes to their clinical and business operations to meet new demands for quality under value-based contracts. This qualitative study was conducted in the context of New York State's efforts to implement VBP among SUD treatment providers to understand their experiences, challenges, and needs. Five focus groups were conducted across the State with a total of 68 treatment professionals. Content analysis was conducted and five themes emerged. First, competing demands, limited workforce and technology infrastructure, and perceived lack of information were leading to overwhelmed administrators. Second, confusion and financial fear was being driven by the need for new clinical roles, business practices, and external partnerships. Third, providers were undertaking a number of measures to address workforce needs. Fourth, providers were building new business models and clinical practices. Fifth, providers desired more support and information. As VBP models are being adopted, healthcare systems should identify ways to mitigate challenges and support SUD treatment providers that may have limited resources to address complex workforce, client, and infrastructure needs.
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Affiliation(s)
- Megan A O'Grady
- Center on Addiction, Division of Health Services Research, NY, USA
| | - Patricia Lincourt
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Evan Gilmer
- Center on Addiction, Division of Health Services Research, NY, USA
| | - Michael Kwan
- Center on Addiction, Division of Health Services Research, NY, USA
| | - Constance Burke
- New York State Office of Addiction Services and Supports, Albany, NY, USA
| | - Carla Lisio
- Center on Addiction, Division of Health Services Research, NY, USA
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11
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O'Grady MA, Lincourt P, Hussain S, Gilmer E, Neighbors CJ. An instrument for assessing progress in substance use disorder treatment: a pilot study of initial reliability and factor structure of the Treatment Progress Assessment-8. J Addict Dis 2019; 38:49-54. [PMID: 31870228 DOI: 10.1080/10550887.2019.1695512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
New instruments are needed to assist substance use disorder (SUD) clinics in monitoring client treatment progress. This paper describes the development of an 8-item monitoring tool and results from a pilot to understand the tool's structure and reliability. 393 clients completed the tool upon treatment entry. A factor analysis resulted in a 2-factor solution: SUD symptoms and treatment progress. Multiple regression analyses showed that clients in inpatient detoxification had lower scores than those in less intensive levels of care. Acceptable internal consistency reliability was found. This study shows promise for the tool and sets the stage for future validation work.
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Affiliation(s)
- Megan A O'Grady
- Division of Health Services Research, Center on Addiction, New York, USA
| | - Patricia Lincourt
- Addiction Treatment and Recovery, New York State Office of Alcoholism and Substance Abuse Services, New York, USA
| | - Shazia Hussain
- Practice Innovation and Care Management, New York State Office of Alcoholism and Substance Abuse Services, New York, USA
| | - Evan Gilmer
- Division of Health Services Research, Center on Addiction, New York, USA
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12
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Gonzales-Castaneda R, McKay JR, Steinberg J, Winters KC, Yu CH(A, Valdovinos IC, Casillas JM, McCarthy KC. Testing mediational processes of substance use relapse among youth who participated in a mobile texting aftercare project. Subst Abus 2019; 43:1-12. [PMID: 31638878 PMCID: PMC7174140 DOI: 10.1080/08897077.2019.1671941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The goal of this paper is to advance the understanding of mechanisms of action involved in behavioral-driven aftercare interventions for substance use disorders (SUDs) among youth populations. This paper reports data from a study that measured the impact of an aftercare intervention on primary substance use relapse among youth who completed treatment in Los Angeles County for SUDs. The aftercare intervention, Project ESQYIR-Educating and Supporting inQuisitive Youth In Recovery, utilized text messaging to monitor relapse and recovery processes, provide feedback, reminders, support, and education among youth from SUD specialty settings during the initial 3-month period following treatment completion. Method: Mediational modeling informed by Baron and Kenny was used to examine the extent to which select recovery processes including participation in extracurricular activities and self-help, were impacted by the texting intervention, and if such processes helped sustain recovery and prevent primary substance use relapse. The data come from a two-group randomized controlled pilot study testing the initial efficacy of a mobile health texting aftercare intervention among 80 youth (Mage= 20.7, SD = 3.5, range: 14-26 years) who volunteered to participate after completing SUD treatment between 2012 and 2013. Results: Among the two recovery processes examined in the mediational modeling, only involvement in extracurricular activities mediated the effects of the texting aftercare intervention on reductions in primary substance use relapse; not self-help participation. Conclusion: Findings from this pilot study offer greater understanding about potential recovery-related mechanisms of action of mobile aftercare interventions. Mobile texting was found to promote increased engagement in recovery-related behaviors such as participation in extracurricular activities, which mediated the effects of the mobile aftercare intervention on decreasing primary substance use relapse. Findings suggest mobile approaches may be effective for increasing adherence to a wide-array of recovery behavioral regiments among youth populations challenged by complex behavioral issues.
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Affiliation(s)
- Rachel Gonzales-Castaneda
- University of California at Los Angeles, Integrated Substance Abuse Programs, Los Angeles, CA
- Azusa Pacific University, Psychology Department, Azusa, CA
| | - James R. McKay
- University of Pennsylvania, Center on the Continuum of Care in the Addictions, Philadelphia, PA
| | - Jane Steinberg
- Azusa Pacific University, Psychology Department, Azusa, CA
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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13
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Neighbors CJ, Choi S, Healy S, Yerneni R, Sun T, Shapoval L. Age related medication for addiction treatment (MAT) use for opioid use disorder among Medicaid-insured patients in New York. Subst Abuse Treat Prev Policy 2019; 14:28. [PMID: 31238952 PMCID: PMC6593566 DOI: 10.1186/s13011-019-0215-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/30/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Medication for addiction treatment (MAT) has received much attention in recent years for treating individuals with opioid use disorders (OUD). However, these medications have been significantly underused among particular subgroups. In this paper, we describe the age distribution of treatment episodes for substance use disorder among Medicaid beneficiaries in New York and corresponding MAT use. METHODS Using New York Medicaid claims, we identified individuals with OUD that received treatment for substance use disorder in 2015. The type of substance use treatment is the primary outcome measure, which includes methadone, buprenorphine, naltrexone or other non-medication treatment. RESULTS A total of 88,637 individuals were diagnosed with OUD and received treatment for substance use disorder and 56,926 individuals received some type of MAT in 2015, with 40.2% receiving methadone, 21.9% receiving buprenorphine and 2.2% receiving naltrexone while 21.9% received non-medication based treatment. Young adults (ages 18-29) were a large proportion (25%) of individuals in treatment for OUD yet were the least likely to receive MAT. Relative to young adults, 30-39 year olds (adjusted odds ratio [AOR] = 1.62, 95% CI = 1.56-1.68), 40-49 year olds (AOR = 1.90, 95% CI = 1.82-1.99), 50-59 year olds (AOR = 2.65, 95% CI = 2.52-2.78), and 60-64 year olds (AOR = 5.03, 95% CI = 4.62-5.48) were more likely to receive MAT. CONCLUSIONS These preliminary findings highlight high numbers of young adults in treatment for OUD and low rates of MAT, which is not consistent with treatment guidelines. Significant differences exist in the type of medication prescribed across age. More attention is needed to address the treatment needs among individuals of different age, notably young adults.
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Affiliation(s)
| | - Sugy Choi
- Center on Addiction, New York, NY, USA
- Boston University School of Public Health, Boston, MA, USA
| | | | | | - Tong Sun
- New York State Office of Alcoholism and Substance Abuse Services (OASAS), Albany, NY, USA
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14
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Sundström C, Petersén E, Sinadinovic K, Gustafsson P, Berman AH. Identification and management of alcohol use and illicit substance use in outpatient psychiatric clinics in Sweden: a national survey of clinic directors and staff. Addict Sci Clin Pract 2019; 14:10. [PMID: 30841916 PMCID: PMC6404264 DOI: 10.1186/s13722-019-0140-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/27/2019] [Indexed: 11/16/2022] Open
Abstract
Background Swedish national guidelines recommend that all health care settings systematically screen patients for alcohol use and illicit substance use. When hazardous use is identified, it should immediately be addressed, preferably through brief interventions (BI). It is well known that the prevalence of alcohol use and illicit substance use among psychiatric patients is high, but it is not known to what extent screening and BI are routinely carried out in such clinics. Methods Two online surveys investigating the use of screening and BI for alcohol and illicit substances were constructed; one for psychiatric outpatient clinic directors and one for staff at these clinics. The main analyses were calculated as simple frequencies. In secondary analyses, we investigated the associations between substance abuse training, type of clinic and screening/BI delivery. For these analyses, the Chi square test was used. Results Most clinic directors reported that they have guidelines to screen for alcohol (93.1%) and illicit substance use (78.9%) at initial assessment. Fifty percent reported having guidelines for delivering BI when identifying hazardous alcohol use (35.9% for hazardous illicit substance use). Among staff, 66.6% reported always screening for alcohol use and 57.8% reported always screening for illicit substance use at initial assessment. Further, 36.7% reported that they usually deliver BI when identifying hazardous alcohol use (35.7% for hazardous illicit substance use). Secondary analyses indicated that staff with substance abuse training were significantly more likely to screen for alcohol use than staff without such training. Further, staff at psychosis clinics were significantly less likely to screen for both alcohol and substance use than staff at both general and specialist psychiatric clinics. Conclusions Most clinic directors reported having clear guidelines for staff to screen for alcohol use and illicit substance use, but fewer staff members than expected indicated that these guidelines were adhered to. Providing training about substance use disorders for staff may increase use of screening for alcohol use, and psychosis clinics may need to improve their screening routines. Electronic supplementary material The online version of this article (10.1186/s13722-019-0140-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher Sundström
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 113 64, Stockholm, Sweden.
| | - Elisabeth Petersén
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 113 64, Stockholm, Sweden.,Stockholm Center for Dependency Disorders, 118 95, Stockholm, Sweden
| | - Kristina Sinadinovic
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 113 64, Stockholm, Sweden.,Stockholm Center for Dependency Disorders, 118 95, Stockholm, Sweden
| | - Peter Gustafsson
- Department of Sociology, Stockholm University, 114 18, Stockholm, Sweden
| | - Anne H Berman
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services, Stockholm County Council, Norra Stationsgatan 69, 113 64, Stockholm, Sweden.,Stockholm Center for Dependency Disorders, 118 95, Stockholm, Sweden
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15
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Ritter A, Mellor R, Chalmers J, Sunderland M, Lancaster K. Key Considerations in Planning for Substance Use Treatment: Estimating Treatment Need and Demand. J Stud Alcohol Drugs Suppl 2019; Sup 18:22-30. [PMID: 30681945 PMCID: PMC6377022 DOI: 10.15288/jsads.2019.s18.22] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 02/07/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Estimates of the extent of treatment need (defined by the presence of a diagnosis for which there is an effective treatment available) and treatment demand (defined as treatment seeking) are essential parts of effective treatment planning, service provision, and treatment funding. This article reviews the existing literature on approaches to estimating need and demand and the use of models to inform such estimation, and then considers the implications for health planners. METHOD A thematic review of the literature was undertaken, with a focus on covering the key concepts and research methods that have been used to date. RESULTS Both need and demand are important estimates in planning for services but contain many difficulties in moving from the theory of measurement to the practicalities of establishing these figures. Furthermore, the simple quantum of need or demand is limited in its usefulness unless it is matched with consideration of different treatment types and their relative intensity, and/or explored as a function of geography and subpopulation. Modeling can assist with establishing more fine-tuned planning estimates, and is able to take into account both client severity and the various treatment types that might be available. CONCLUSIONS Moving from relatively simplistic estimates of need and demand for treatment, this review has shown that although such estimation can inform national or subnational treatment planning, more sophisticated models are required for alcohol and other drug treatment planning. These can help health planners to determine the appropriate amount and mix of treatments for substance use disorders.
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Affiliation(s)
- Alison Ritter
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Richard Mellor
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Jenny Chalmers
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Matthew Sunderland
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
| | - Kari Lancaster
- Drug Policy Modelling Program, National
Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW,
Australia
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16
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Zhu H, Wu LT. National trends and characteristics of inpatient detoxification for drug use disorders in the United States. BMC Public Health 2018; 18:1073. [PMID: 30157815 PMCID: PMC6114033 DOI: 10.1186/s12889-018-5982-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 08/21/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Prior studies indicate that the opportunity from detoxification to engage in subsequent drug use disorder (DUD) treatment may be missed. This study examined national trends and characteristics of inpatient detoxification for DUDs and explored factors associated with receiving DUD treatment (i.e., inpatient drug detoxification plus rehabilitation) and discharges against medical advice (DAMA). METHODS We analyzed inpatient hospitalization data involving the drug detoxification procedure for patients aged≥12 years (n = 271,403) in the 2003-2011 Nationwide Inpatient Samples. We compared the estimated rate and characteristics of inpatient drug-detoxification hospitalizations between 2003 and 2011 and determined demographic and clinical correlates of inpatient drug detoxification plus rehabilitation (versus detoxification-only) and DAMA (versus transfer to further treatment). RESULTS There was no significant yearly change in the population rate of inpatient drug-detoxification hospitalizations during 2003-2011. The majority of inpatient drug detoxification were patients aged 35-64 years, males, and those on Medicaid. Among inpatient drug-detoxification hospitalizations, only 13% received detoxification plus rehabilitation during inpatient care, and up to 14% were DAMA; the most commonly identified diagnoses were opioid use disorder (OUD; 75%) and non-addiction mental health disorders (48%). Being on Medicaid (vs. having private insurance) and having OUD (vs. no OUD) were associated with decreased odds of receiving detoxification plus rehabilitation, as well as increased odds of DAMA. CONCLUSIONS These findings suggest the presence of a potentially large detoxification-treatment gap for inpatient detoxification patients. They highlight the need for implementing DUD services to improve engagement in receiving further DUD treatment in order to improve recovery and health outcomes.
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Affiliation(s)
- He Zhu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, BOX 3903, Durham, NC, 27710, USA.
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, BOX 3903, Durham, NC, 27710, USA.
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA.
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
- Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, NC, USA.
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17
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Recurrent use of inpatient withdrawal management services: Characteristics, service use, and cost among Medicaid clients. J Subst Abuse Treat 2018; 92:77-84. [PMID: 30032948 DOI: 10.1016/j.jsat.2018.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 11/22/2022]
Abstract
Reducing repeat use of costly inpatient services, such as inpatient withdrawal management, among Medicaid members is a target of healthcare reform. However, characteristics of frequent users of inpatient withdrawal management are understudied. We described the characteristics, service utilization, and costs of New York Medicaid clients who use withdrawal management services by analyzing data from Medicaid records from 2008. We examined follow-up care for individuals with different levels of repeat withdrawal management. We found 32,196 Medicaid withdrawal management patients with a total of 67,073 episodes and we divided patients into low (1 episode, n = 19,602), medium (2-3 episodes, n = 8619) and high (≥4 episodes, n = 3978) use categories. High users had almost 8 times the withdrawal management cost of low users. Similarly, they had 5 times more emergency department visits than low users. High users had high levels of homelessness (75%), 20% had HIV/AIDS, and 40% had Hepatitis. High withdrawal management users were less likely than low users to receive any follow-up treatment services. Medicaid clients with high utilization of inpatient withdrawal management are a small but costly population with poor follow-up rates to subsequent treatment services. They are a socially disenfranchised group that may benefit from targeted services to address their complex clinical needs.
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18
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Pinsky I, Bernal C, Vuolo L, Neighbors C. Introducing care management to Brazil's alcohol and substance use disorder population. ACTA ACUST UNITED AC 2017; 40:320-324. [PMID: 29267603 PMCID: PMC6899403 DOI: 10.1590/1516-4446-2017-2235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/13/2017] [Indexed: 12/26/2022]
Abstract
Brazil has a sizable alcohol and substance use disorder (ASUD) population, yet there are considerable gaps in treatment access and retention. ASUD, a chronic medical condition, is highly comorbid with medical and behavioral health disorders. This indicates a need for more targeted interventions in order to achieve health care integration (a major goal of Brazil's health care system). Care management - that is, the organization of patient care by an institution - is a viable strategy to engage individuals with ASUD who might benefit from treatment but are not aware of or do not use the available resources, as well as to help maintain patients in treatment. Care management is considered an essential supplement to the treatment of chronic disease. The objective of this article is to discuss the applicability of care management for the treatment of ASUD within the public health care system in Brazil. We describe models of care management that have been adopted internationally and identify the feasibility and advantages for its adoption in Brazil.
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Affiliation(s)
- Ilana Pinsky
- The National Center on Addiction and Substance Abuse, New York, USA.,Departamento de Psiquiatria, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Camila Bernal
- The National Center on Addiction and Substance Abuse, New York, USA
| | - Lindsey Vuolo
- The National Center on Addiction and Substance Abuse, New York, USA
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19
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Munro A, Allan J, Shakeshaft A, Breen C. "I just feel comfortable out here, there's something about the place": staff and client perceptions of a remote Australian Aboriginal drug and alcohol rehabilitation service. Subst Abuse Treat Prev Policy 2017; 12:49. [PMID: 29208008 PMCID: PMC5718008 DOI: 10.1186/s13011-017-0135-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The need for effective, culturally safe residential rehabilitation services for Aboriginal people is widely acknowledged, however the combination of treatment components that is optimally effective, is not well defined. Most existing Aboriginal residential rehabilitation research has focused on describing client characteristics, and largely ignored the impact of treatment and service factors, such as the nature and quality of therapeutic components and relationships with staff. METHODS This qualitative study was undertaken as part of a three-year mixed methods community-based participatory research (CBPR) project that aimed to empirically describe a remote Aboriginal drug and alcohol rehabilitation service. Researchers utilised purposive sampling to conduct 21 in-depth, semi-structured interviews. The interviews used a 'research yarning' approach, a form of culturally appropriate conversation that is relaxed and narrative-based. The interview transcripts were thematically coded using iterative categorization. The emerging themes were then analysed from an Interpretative Phenomenological Analysis, focusing on how participants' lived experiences before and during their admission to the service shaped their perceptions of the program. RESULTS A total of 12 clients (mean age 35 years, SD 9.07, 91% Aboriginal) and 9 staff (2 female, 7 male, mean age 48 years, SD 8.54, 67% Aboriginal) were interviewed. Five themes about specific program components were identified in the interview data: healing through culture and country; emotional safety and relationships; strengthening life skills; improved wellbeing; and perceived areas for improvement. This research found that Aboriginal drug and alcohol residential rehabilitation is not just about length of time in treatment, but also about the culture, activities and relationships that are part of the treatment process. CONCLUSION This study highlights that cultural elements were highly valued by both clients and staff of a remote Aboriginal residential rehabilitation service, with the country or location being fundamental to the daily practice of, and access to, culture. Developing reliable and valid assessments of the program components of culture and treatment alliance would be valuable, given this study has reinforced their perceived importance in achieving positive treatment outcomes. Further, strengthening the aftercare program, as part of an integrated model of care, would likely provide greater support to clients after discharge.
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Affiliation(s)
- Alice Munro
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | | | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
| | - Courtney Breen
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW Australia
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20
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BrintzenhofeSzoc K, Gilbert C. Social workers have an obligation to all patients regarding confidentiality … however, for some patients, the obligation is greater. SOCIAL WORK IN HEALTH CARE 2017; 56:779-793. [PMID: 28699843 DOI: 10.1080/00981389.2017.1343216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Social workers are held to many ethical obligations regarding patients including maintaining patient confidentiality and staying up to date on confidentiality laws, statutes, and regulations. As the landscape of health care continues to change, including the increased use of technology to maintain patient records, highlights this need. The changes in the regulations on confidentiality of those who are receiving substance use treatment, 42 CFR Part 2, are presented. The other regulations and laws covered include HIPAA, HITECH, and the ACA. This includes the changes that have taken place, how to be compliant, and which to follow when.
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Affiliation(s)
- Karlynn BrintzenhofeSzoc
- a School of Social Work, College of Allied Health Sciences , University of Cincinnati , Cincinnati , OH , USA
| | - Caitlyn Gilbert
- a School of Social Work, College of Allied Health Sciences , University of Cincinnati , Cincinnati , OH , USA
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21
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Hunt P, Hunter SB, Levan D. Continuous quality improvement in substance abuse treatment facilities: How much does it cost? J Subst Abuse Treat 2017; 77:133-140. [PMID: 28189289 PMCID: PMC8664292 DOI: 10.1016/j.jsat.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
Continuous quality improvement (CQI) has grown in the U.S. since the 1970s, yet little is known about the costs to implement CQI in substance abuse treatment facilities. This paper is part of a larger group randomized control trial in a large urban county evaluating the impact of Plan-Study-Do-Act (PDSA)-CQI designed for community service organizations (Hunter, Ober, Paddock, Hunt, & Levan, 2014). Operated by one umbrella organization, each of the eight facilities of the study, four residential and four outpatient substance abuse treatment facilities, selected their own CQI Actions, including administrative- and clinical care-related Actions. Using an activity-based costing approach, we collected labor and supplies and equipment costs directly attributable to CQI Actions over a 12-month trial period. Our study finds implementation of CQI and meeting costs of this trial per facility were approximately $2000 to $10,500 per year ($4500 on average), or $10 to $60 per admitted client. We provide a description of the sources of variation in these costs, including differing intensity of the CQI Actions selected, which should help decision makers plan use of PDSA-CQI.
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Affiliation(s)
- Priscillia Hunt
- RAND Corporation, Santa Monica, CA, USA; Institute for the Study of Labor (IZA), Bonn, Germany.
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22
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Quinn AE, Stewart MT, Brolin M, Horgan C, Lane NE. Massachusetts Substance Use Disorder Treatment Organizations' Perspectives on the Affordable Care Act: Changes in Payment, Services, and System Design. J Psychoactive Drugs 2017; 49:151-159. [PMID: 28350232 PMCID: PMC5701571 DOI: 10.1080/02791072.2017.1301600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Affordable Care Act (ACA) expanded insurance benefits and coverage for substance use disorder (SUD) treatment and encouraged delivery and payment reforms. Massachusetts passed a similar reform in 2006. This study aims to assess Massachusetts SUD treatment organizations' responses to the ACA. Organizational interviews addressing challenges of and responses to the ACA were conducted in person June-December 2014 with 31 leaders at 12 treatment organizations across Massachusetts. Many organizations were affiliated with medical or social services and offered a range of SUD services. Sampling was based on services offered (detoxification only, detoxification and outpatient, outpatient only). Framework analysis was used. Challenges identified were considered similar to ongoing challenges, not unique to the ACA. Organizations experienced insurance expansions in 2006 and faced new challenges, including insurance coverage, payment arrangements, expansion of services, and system design. System design efforts included care coordination/integration, workforce development, and health information technology. Differences in responses related to connections with medical and social service organizations. Many organizations engaged in efforts to respond to changing policies by expanding capacity and services. Offering a range of SUD treatment (e.g., detoxification and outpatient) and affiliating with a medical organization could enable organizations to respond to new insurance, delivery, and payment reforms.
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Affiliation(s)
- Amity E. Quinn
- Senior Research Associate (AEQ); Scientist (MTS); Scientist (MB);
Professor and Director (CH) Institute for Behavioral Health, The Heller School for
Social Policy and Management, Brandeis University, Waltham, MA
| | - Maureen T. Stewart
- Senior Research Associate (AEQ); Scientist (MTS); Scientist (MB);
Professor and Director (CH) Institute for Behavioral Health, The Heller School for
Social Policy and Management, Brandeis University, Waltham, MA
| | - Mary Brolin
- Senior Research Associate (AEQ); Scientist (MTS); Scientist (MB);
Professor and Director (CH) Institute for Behavioral Health, The Heller School for
Social Policy and Management, Brandeis University, Waltham, MA
| | - Constance Horgan
- Senior Research Associate (AEQ); Scientist (MTS); Scientist (MB);
Professor and Director (CH) Institute for Behavioral Health, The Heller School for
Social Policy and Management, Brandeis University, Waltham, MA
| | - Nancy E. Lane
- Senior VP, Population Health Management, Vanderbilt University
Medical Center and Assistant Clinical Professor of Psychiatry, Vanderbilt Medical
School, Nashville, TN
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