DoubleTree Hotel
Rockville, Maryland
December 9, 1997

Bennett Fletcher, Ph.D.
Chief, Services Research Branch
Division of Clinical and Services Research

Summary

Health services research studies the impact of the organization, financing, and management of health services on the quality, cost, access to, and outcomes of care.

Meeting Goals:

• Begin to develop an agenda for health services research on drug abuse treatment and prevention;
• Define the priority areas for health services research, including cost, financing, and managed care; effectiveness and outcomes; organization and management; and prevention;
• Identify researchers within and outside of drug abuse research and the issues of recruiting and training new researchers;
• Plan upcoming meetings, identify boundaries between research areas, determine issues to include, and consider peripheral services.

Meeting Process:

The agenda included discussions that defined the goals for health services research on drug abuse prevention and treatment in the areas of managed care, cost and financing, management and organization, and effectiveness and outcomes. The meeting goals were used to develop a plan for NIDA’s health services research agenda by identifying important research areas, meeting topics, and participants.

Content:

The following key issues resulted from the meeting:

Critical issues included:

• The public is not disposed to believe that treatment works.
• Research rigor versus relevance needs to be addressed.
• Research outcomes need to be communicated effectively.

Three target audiences for health services research were conceptualized:

• Legislators
• Health care providers
• General public

Four distinct meeting topics in health services research became apparent:

• Organization and Management
• Effectiveness and Outcomes
• Economics and Financing
• Prevention

Cross-cutting the primary topics to form a matrix were:

• Definitions
• Education
• Managed care
• Methodology (measurement and instruments)
• Special needs populations, including homeless individuals and pregnant women
• Access to services

Organization and Management research issues include:

• Studies of treatment environment, services providers, and regulatory accreditation.
• Transactions (often small) between organizations and their environment (linkages), including didactic studies, managed care, service networks, and community groups.
• Internal organization of service providers, managers, staff, client motivation, and staff incentives.
• Conceptual frameworks, including theories of work motivation and environments.
• Technology transfer and organizational change.

Effectiveness and Outcomes research issues and recommendations:

• Increase research to modify efficacy designs or broaden research to incorporate other areas.
• Enhance opportunities to incorporate clinical research into services research.
• Identify and catalog exemplary studies that have begun to yield results.
• Discuss methodological issues involving integration of utilization data on effectiveness research.
• Establish priorities of outcome study type, including cost, price, and charges.
• Pursue development of outcome and performance measurements.
• Determine the impact on other programs in cost offsets or problem reductions (e.g., criminal justice).
• Define quality and outcome standards.

Economics: Cost and Financing research issues:

• Reimbursement – type, availability, and accessibility
• Cost-shifting
• Responsibility-shifting
• Access and utilization
• Costs to society
• Health insurance and parity
• Coverage
• Current coverage and limits
• Recommendations for effectiveness
  

Prevention research issues:

• Current state of research remains at fundamental stages of categorizing, describing, locating, and identifying.
• Community-based research is more relevant than clinical studies.
• Cost and funding information needs to be expanded.
• Linkages with managed care organizations should be explored, especially
• Special needs populations
• Marketing strategies
• Integrated treatment services (e.g., supported housing) act as prevention services, preventing relapse to drug use.
• Community fit and values are important for mass distribution of prevention services.
• Better methodology and tracking instruments are needed for large-scale studies.

Conclusion:

Meeting participants agreed that four substantive areas exist that provide a structure for addressing health services research in drug abuse treatment and prevention. These topics include Organization and Management, Effectiveness and Outcomes, Economics and Financing, and Prevention. Each of these areas will be addressed in a separate meeting during the spring of 1998.

Products and Follow-up:

• Four meetings will be held in the spring of 1998, addressing the Health Services Research topics of Organization and Management, Effectiveness and Outcomes, Economics and Financing, and Prevention.

• Each meeting will make recommendations to present at the NIDA-sponsored symposium, Forging the Link: Health Services Research on Drug Abuse Prevention and Treatment, to be held in conjunction with the Annual Meeting of the Association for Health Services Research in June 1998. Presentations by each group will include:
  • State of the science
  • Issues and priorities
  • Future directions
  • Five-year plan
  • NIDA’s research agenda

• Meeting attendees will recruit new members to participate in the follow-up meetings. Participants from the initial meeting will be dispersed among the four meetings, with several individuals acting as bridges between the meetings.

• The development of a short brochure that addresses health service research issues is under consideration.