D'Aunno Thomas, Pollack Harold, Chen Qixuan, Friedmann Peter D
*New York University Wagner School of Public Service, New York University College of Global Public Health, New York University, New York, NY †University of Chicago, Chicago, IL ‡Columbia University, New York, NY §Department of Health Services, Policy & Practice, Brown University, Providence, RI.
Med Care. 2017 Apr;55(4):379-383. doi: 10.1097/MLR.0000000000000645.
To meet their aims of providing comprehensive and coordinated care, patient-centered medical homes (PCMHs) need to coordinate services for individuals with substance use disorders. Yet, the 14,000 addiction treatment (AT) organizations across the United States that provide services for more than 1 million individuals daily are generally ill-prepared to work with PCMHs (eg, AT organizations often lack electronic health records).
To examine the extent to which AT organizations have formal linkages through contracts with PCMHs; to identify key dimensions of linkages between PCMHs and AT organizations (eg, shared use of electronic health records); to identify characteristics of AT organizations and their environments associated with these linkages.
We draw on data from a 2014 nationally representative survey of directors and clinical supervisors from 695 AT organizations (n=1390 survey respondents).
Thirty-eight percent of patients across the nation are receiving treatment in AT organizations linked by contracts to PCMHs. This number increases to 51% in states that expanded Medicaid (vs. only 6.2% of patients in non-Medicaid expansion states). Yet, the great majority of linkages are relatively weak; they do not include the exchange of patient information. Results from multivariable analyses show that larger, nonprofit and publicly owned AT organizations, as well as those located in the northeast and in states that expanded Medicaid coverage, are more likely to have contracts with PCMHs.
Without stronger linkages between AT organizations and PCMHs or the development of other models that integrate services, individuals with substance abuse disorders may continue to receive uncoordinated care.
为实现提供全面且协调的医疗服务这一目标，以患者为中心的医疗之家（PCMHs）需要为患有物质使用障碍的个体协调服务。然而，美国全国范围内为超过100万人提供日常服务的14000个成瘾治疗（AT）组织，通常没有做好与PCMHs合作的准备（例如，AT组织往往缺乏电子健康记录）。
研究AT组织通过与PCMHs签订合同建立正式联系的程度；确定PCMHs与AT组织之间联系的关键维度（例如，电子健康记录的共享使用）；确定与这些联系相关的AT组织及其环境的特征。
我们利用了2014年对695个AT组织的主任和临床主管进行的全国代表性调查的数据（n = 1390名调查受访者）。
全国38%的患者在通过合同与PCMHs建立联系的AT组织接受治疗。在扩大医疗补助计划的州，这一比例增至51%（相比之下，非医疗补助计划扩大州只有6.2%的患者）。然而，绝大多数联系相对薄弱；它们不包括患者信息的交换。多变量分析结果表明，规模较大、非营利性和公有制的AT组织，以及位于东北部和扩大了医疗补助覆盖范围的州的组织，更有可能与PCMHs签订合同。
如果AT组织与PCMHs之间没有更紧密的联系，或者没有开发出整合服务的其他模式，患有物质滥用障碍的个体可能会继续接受不协调的医疗服务。
