Matching, Outcomes and Costs in Substance Abuse/Psychiatric Treatment
Christine Timko PhD
VA Palo Alto Health Care System
Palo Alto, CA
Funding Period: October 1997 - August 2001

BACKGROUND/RATIONALE:
This project is providing information on current efforts to transfer mental health care away from hospitals and to match patients to different types of community care. Its ultimate goal is to improve the quality of care and reduce treatment costs for veterans with substance abuse and psychiatric problems.

OBJECTIVE(S):
This project is evaluating a patient-treatment matching strategy to improve hospital- and community-based residential treatment for substance abuse patients with psychiatric disorders. Its immediate objective is to examine whether the matching strategy results in more effective and cost-effective treatment in VA programs. We hypothesize that patients with severe clinical and functional problems will have better outcomes when they are matched to service-intensive programs; patients with moderate problems will have better outcomes when they are matched to programs having a lower intensity of services. For both patient groups, community-based treatment should prove to be more cost-effective than hospital-based treatment.

METHODS:
The project is utilizing a stratified randomized design. We have paired each of three VA hospital-based programs that treat dual diagnosis patients and are high on intensity with a nearby high-intensity community residential facility (CRF) that contracts with the VA. We have also paired four VA hospital and four community programs that are low on intensity. Veterans who apply for substance abuse treatment at VA facilities are randomly assigned to either the VA hospital or community program. Patient assessments are conducted at intake (to date, N=224), discharge, and 4- and 12-month follow-ups. Primary outcomes are patients’ severity of substance abuse and psychiatric problems. Secondary outcomes are patients’ functional status and their VA and non-VA health care utilization and its costs.

FINDINGS/RESULTS:
Initial findings concern the first step of this project, which involved collecting information on substance abuse and psychiatric treatment programs in VAs and CRFs nationwide, for the purpose of selecting program pairs. Specifically, we have compared VA’s psychiatric and substance abuse treatment systems on organizational factors, staffing, management practices, policies, and services within inpatient, residential, intensive outpatient, and standard outpatient modalities. We have also compared inpatient to residential care on these program characteristics. We plan to compare psychiatric and substance abuse programs that treat dual diagnosis patients on these factors.

IMPACT:
If supported, the matching strategy can be used by decisionmakers at a number of levels to enhance the therapeutic effectiveness and reduce the treatment costs of VA substance abuse and psychiatric services. The matching treatment model will be useful to system planners to identify patient and system needs that can be addressed by new program initiatives and training approaches, to ensure that the system includes the full range of treatment alternatives to which patients may be optimally matched. Substance abuse and psychiatric program managers will also find the matching strategy useful for clarifying and improving their program’s capacity to successfully treat substance abuse patients with psychiatric disorders. Individual case managers can use the matching treatment model to assess the capacity of components of their own system to meet the needs of individual clients.

PUBLICATIONS:

Journal Articles

1. Chen S, Barnett PG, Sempel JM, Timko C. Outcomes and costs of matching the intensity of dual-diagnosis treatment to patients' symptom severity. Journal of Substance Abuse Treatment. 2006; 31(1): 95-105.
2. Timko C, Sempel JM. Short-term outcomes of matching dual diagnosis patients' symptom severity to treatment intensity. Journal of Substance Abuse Treatment. 2004; 26(3): 209-18.
3. Timko C, Sempel JM. Intensity of acute services, self-help attendance and one-year outcomes among dual diagnosis patients. Journal of Studies On Alcohol. 2004; 65(2): 274-82.
4. Timko C, Sempel JM, Moos RH. Models of standard and intensive outpatient care in substance abuse and psychiatric treatment. Administration and Policy in Mental Health. 2003; 30(5): 417-36.
5. Timko C, Lesar M, Calvi NJ, Moos RH. Trends in acute mental health care: comparing psychiatric and substance abuse treatment programs. The Journal of Behavioral Health Services & Research. 2003; 30(2): 145-60.
6. Timko C, Yu K, Moos RH. Demand characteristics of residential substance abuse treatment programs. Journal of Substance Abuse. 2000; 12(4): 387-403.
7. Timko C, Lesar M, Engelbrekt M, Moos RH. Changes in services and structure in community residential treatment facilities for substance abuse patients. Psychiatric Services. 2000; 51(4): 494-8.

DRA: Health Services and Systems, Mental Illness, Substance Abuse, Addictive Disorders
DRE: Quality of Care, Resource Use and Cost, Technology Development and Assessment
Keywords: Dual diagnosis – substance abuse and mental health, Patient outcomes
MeSH Terms: Diagnosis, Dual