Spear Suzanne E
University of Southern California, School of Social Work, USA.
Drug Alcohol Depend. 2014 Apr 1;137:76-82. doi: 10.1016/j.drugalcdep.2014.01.006. Epub 2014 Jan 25.
The high cost of detoxification (detox) services and health risks associated with continued substance abuse make readmission to detox an important indicator of poor performance for substance use disorder treatment systems. This study examined the extent to which the structure of local networks available to detox programs affects patients' odds of readmission to detox within 1 year.
Administrative data from 32 counties in California in 2008-2009 were used to map network ties between programs based on patient transfers. Social network analysis was employed to measure structural features of detox program networks. Contextual predictors included efficiency (proportion of ties within a network that are non-redundant) and out-degree (number of outgoing ties to other programs). A binary mixed model was used to predict the odds of readmission among detox patients in residential (non-hospital) facilities (N=18,278).
After adjusting for patient-level covariates and continuity of service from detox to outpatient or residential treatment, network efficiency was associated with lower odds of readmission.
The impact of network structure on detox readmissions suggests that the interorganizational context in which detox programs operate may be important for improving continuity of service within substance use disorder treatment systems. Implications for future research are discussed.
戒毒服务成本高昂，且持续药物滥用会带来健康风险，这使得再次入院戒毒成为物质使用障碍治疗系统表现不佳的一个重要指标。本研究考察了戒毒项目可利用的当地网络结构在多大程度上影响患者在1年内再次入院戒毒的几率。
利用2008 - 2009年加利福尼亚州32个县的行政数据，根据患者转诊情况绘制项目之间的网络联系。采用社会网络分析来衡量戒毒项目网络的结构特征。背景预测因素包括效率（网络中非冗余联系的比例）和出度（与其他项目的外向联系数量）。使用二元混合模型预测住院（非医院）设施中戒毒患者再次入院的几率（N = 18,278）。
在调整了患者层面的协变量以及从戒毒到门诊或住院治疗的服务连续性后，网络效率与再次入院几率较低相关。
网络结构对戒毒再入院的影响表明，戒毒项目运作的组织间背景对于改善物质使用障碍治疗系统内的服务连续性可能很重要。讨论了对未来研究的启示。
