Rosenheck Robert A, Seibyl Catherine L
Department of Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut 06516, USA.
Psychiatr Serv. 2005 Mar;56(3):301-7. doi: 10.1176/appi.ps.56.3.301.
The use of outcome assessment to evaluate the performance of programs over many years of operation is becoming an increasingly important aspect of health care management. Over a five-year period of program monitoring, this study examined changes in individual client outcomes three months after discharge from a residential work therapy program for veterans with severe substance use disorders. The study also examined the relationship between these outcomes and changing program features, such as staffing, treatment variables, and follow-up rates.
Data on admissions characteristics, services delivered during treatment, and status at discharges were collected for 3,390 veterans who were treated in 25 sites in the Department of Veterans Affairs' Compensated Work Therapy/Transitional Residence program. Follow-up data were gathered three months after discharge for 1,771 veterans (52.2 percent). Hierarchical linear modeling was used to examine the association between year of discharge, site-level measures of program staffing and follow-up rate, and individual patient-level treatment variables and outcomes.
Over the five-year monitoring period, site staff-to-bed ratios and follow-up rates dropped substantially, and veterans attended more Alcoholics Anonymous and Narcotics Anonymous meetings and had more toxicology screens. Higher staff-to-bed ratios were associated with more positive employment outcomes, and higher follow-up rates were associated with poorer outcomes in substance abuse and lower total income. However, no significant outcome trends were observed in clinical follow-up measures after the analyses adjusted for these factors, suggesting that program effectiveness did not deteriorate during a period of program change.
Long-term evaluations of program process and follow-up status can usefully document sustained program effectiveness over many years. Such efforts should enhance their value by examining and adjusting for the impact of factors such as changing staffing levels and follow-up rates.
运用结果评估来评价项目多年运营的表现，正日益成为医疗保健管理的一个重要方面。在为期五年的项目监测期间，本研究调查了患有严重物质使用障碍的退伍军人从住院工作治疗项目出院三个月后个体客户结果的变化。该研究还考察了这些结果与项目特征变化之间的关系，如人员配备、治疗变量和随访率。
收集了在退伍军人事务部的有偿工作治疗/过渡性住所项目的25个地点接受治疗的3390名退伍军人的入院特征、治疗期间提供的服务以及出院时状况的数据。在出院三个月后收集了1771名退伍军人（52.2%）的随访数据。采用分层线性模型来检验出院年份、项目人员配备和随访率的机构层面指标，以及个体患者层面的治疗变量与结果之间的关联。
在五年的监测期内，机构的工作人员与床位比例以及随访率大幅下降，退伍军人参加戒酒互助会和戒毒互助会会议的次数增多，接受毒理学筛查的次数也更多。较高的工作人员与床位比例与更积极的就业结果相关，而较高的随访率与药物滥用方面较差的结果以及较低的总收入相关。然而，在对这些因素进行分析调整后，临床随访指标中未观察到显著的结果趋势，这表明在项目变化期间项目效果并未恶化。
对项目过程和随访状况进行长期评估，有助于记录多年来项目持续的有效性。通过考察和调整人员配备水平和随访率等因素的影响，此类工作应能提升其价值。
