Rohrer J E, Vaughan M S, Cadoret R J, Carswell C, Patterson A, Zwick J
Graduate Program in Hospital and Health Administration, University of Iowa, Iowa City, USA.
Psychiatr Serv. 1996 Nov;47(11):1233-8. doi: 10.1176/ps.47.11.1233.
State governments are exploring the potential of various forms of case management to control the costs of substance abuse treatment programs. This report describes an experimental program in one Iowa county in which clients are assessed and referred elsewhere if treatment is needed. Outcomes of clients in that county are compared with those of clients served elsewhere in the state.
All claims submitted by provider agencies to the Iowa Department of Public Health for substance abuse treatment of eligible clients in 1994 were analyzed to test the effect of the experimental intake-and-referral program on clients' utilization of outpatient treatment, rate of treatment completion, and rate of abstention at discharge from treatment.
In the county with the experimental program, 27 percent of clients recommended for treatment actually attended, compared with 48 percent in other counties. Clients who used the experimental program were also less likely to complete treatment. These differences persisted after adjusting for baseline differences in client characteristics.
Lower utilization arising from failure to attend recommended treatment may reduce treatment costs but is not the intended outcome of the intake-and-referral program. Failure to complete treatment also is an adverse outcome. Outcomes of various types of case management programs should be carefully evaluated before statewide implementation is considered.
州政府正在探索各种形式的病例管理在控制药物滥用治疗项目成本方面的潜力。本报告描述了爱荷华州一个县的一个实验项目，在该项目中，对客户进行评估，如有需要则转介到其他地方。将该县客户的结果与该州其他地方服务的客户的结果进行比较。
分析了1994年供应商机构向爱荷华州公共卫生部提交的所有符合条件客户的药物滥用治疗索赔，以测试实验性的 intake-and-referral 项目对客户门诊治疗利用率、治疗完成率和出院时戒酒率的影响。
在实施实验项目的县，被建议治疗的客户中实际就诊的比例为27%，而其他县为48%。使用实验项目的客户完成治疗的可能性也较小。在对客户特征的基线差异进行调整后，这些差异仍然存在。
因未参加建议治疗而导致的利用率降低可能会降低治疗成本，但这并非 intake-and-referral 项目的预期结果。未能完成治疗也是一个不良结果。在考虑在全州范围内实施之前，应仔细评估各种类型病例管理项目的结果。
