Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States; Department of Community Health, Tufts University, United States.
Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States.
Drug Alcohol Depend. 2018 Feb 1;183:192-200. doi: 10.1016/j.drugalcdep.2017.11.009. Epub 2017 Dec 16.
Despite the importance of continuity of care after detoxification and residential treatment, many clients do not receive further treatment services after discharged. This study examined whether offering financial incentives and providing client-specific electronic reminders to treatment agencies lead to improved continuity of care after detoxification or residential treatment.
Residential (N = 33) and detoxification agencies (N = 12) receiving public funding in Washington State were randomized into receiving one, both, or none (control group) of the interventions. Agencies assigned to incentives arms could earn financial rewards based on their continuity of care rates relative to a benchmark or based on improvement. Agencies assigned to electronic reminders arms received weekly information on recently discharged clients who had not yet received follow-up treatment. Difference-in-difference regressions controlling for client and agency characteristics tested the effectiveness of these interventions on continuity of care.
During the intervention period, 24,347 clients received detoxification services and 20,685 received residential treatment. Overall, neither financial incentives nor electronic reminders had an effect on the likelihood of continuity of care. The interventions did have an effect among residential treatment agencies which had higher continuity of care rates at baseline.
Implementation of agency-level financial incentives and electronic reminders did not result in improvements in continuity of care, except among higher performing agencies. Alternative strategies at the facility and systems levels should be explored to identify ways to increase continuity of care rates in specialty settings, especially for low performing agencies.
尽管戒毒和住院治疗后的延续性护理很重要，但许多患者在出院后并未接受进一步的治疗服务。本研究旨在探讨提供经济激励措施和向治疗机构提供个性化的电子提醒是否能改善戒毒或住院治疗后的延续性护理。
华盛顿州接受公共资金的住院（N=33）和戒毒机构（N=12）被随机分配接受一项、两项或均不接受（对照组）干预措施。激励措施组的机构可以根据其相对于基准或改善的延续性护理率获得经济奖励。被分配到电子提醒组的机构每周都会收到最近出院但尚未接受后续治疗的患者的信息。通过控制客户和机构特征的差异回归，检验了这些干预措施对延续性护理的有效性。
在干预期间，共有 24347 名患者接受了戒毒服务，20685 名患者接受了住院治疗。总体而言，经济激励措施和电子提醒都没有对延续性护理的可能性产生影响。干预措施对延续性护理率较高的住院治疗机构有影响。
机构层面的经济激励措施和电子提醒的实施并没有改善延续性护理，除了在表现较好的机构中。应在设施和系统层面探索替代策略，以确定如何在专科环境中提高延续性护理率，特别是针对表现较差的机构。
