Shwartz M, Mulvey K P, Woods D, Brannigan P, Plough A
School of Management, Boston University, MA 02215, USA.
J Subst Abuse Treat. 1997 Jan-Feb;14(1):11-8. doi: 10.1016/s0740-5472(96)00095-5.
Longer length of stay (LOS) in substance abuse treatment, a standard measure of treatment success, conflicts with pressures from managed care. To maintain LOS as an outcome, we identified, for four modalities, LOS categories such that program completion rates were relatively constant within category and differed among categories. We validated the cutoffs by showing that future utilization over a 2-year period by clients differed by category. Clients in the long-LOS category used the system in a way consistent with more successful treatment. Thus, rather than using increase in LOS as an outcome, one can use increase in the percentage of clients reaching the long-LOS category. Categories were developed and utilization analyzed for discharges from publicly funded Boston treatment programs between 1/92 and 12/94 from the following modalities: short-term residential (5,462 discharges), long-term residential (5,086 discharges), outpatient (13,656 discharges), and detox (19,965 discharges).
在药物滥用治疗中，住院时间延长（LOS）作为治疗成功的一项标准指标，与管理式医疗的压力相冲突。为了将住院时间作为一项成果指标保留下来，我们针对四种治疗方式确定了住院时间类别，使得项目完成率在类别内相对稳定，而在不同类别间存在差异。我们通过证明不同类别的客户在两年内的未来利用率有所不同，从而验证了这些临界值。处于长住院时间类别的客户使用该系统的方式与更成功的治疗方式一致。因此，与其将住院时间的增加作为一项成果指标，不如使用达到长住院时间类别的客户百分比的增加。我们针对1992年1月至1994年12月期间从以下治疗方式中出院的、由公共资金资助的波士顿治疗项目进行了类别划分并分析了利用率：短期住院（5462例出院）、长期住院（5086例出院）、门诊治疗（13656例出院）和戒毒治疗（19965例出院）。
