Abstract：
OBJECTIVE:To assess the effectiveness and cost-effectiveness of four treatment modalities for substance abuse. DATA SOURCES:The study used data from the Services Research Outcomes Study (SROS), a survey of 3,047 clients in a random sample of 99 drug treatment facilities across the United States. Detailed sociodemographic, substance use, and clinical data were abstracted from treatment records. Substance abuse outcome and treatment history following discharge from index facilities were assessed using a comprehensive interview with 1,799 of these individuals five years after discharge. Treatment success was defined in two ways: as abstinence and as any reduction in substance use. STUDY DESIGN:Effectiveness and cost-effectiveness of four modalities were compared: inpatient, residential, outpatient detox/methadone, and outpatient drug-free. Clients were stratified based on propensity scores and analyses were conducted within these strata. Sensitivity analyses examined the impact of future substance abuse treatment on effectiveness and cost-effectiveness estimates. PRINCIPAL FINDINGS:Treatment of substance disorders appears to be cost-effective compared to other health interventions. The cost per successfully treated abstinent case in the least costly modality, the outpatient drug-free programs, was 6,300 dollars (95 percent confidence intervals: 5,200-7,900 dollars) in 1990 dollars. There were only minor differences between various modalities of treatment with regard to effectiveness. However, modalities varied considerably with regard to cost-effectiveness. Outpatient drug-free programs were the most cost-effective. There was little evidence that relative effectiveness or cost-effectiveness of programs varied according to factors that were associated with selection into different programs. CONCLUSIONS:Substance disorders can be treated most cost-effectively in outpatient drug-free settings. Savings from transitioning to the most cost-effective treatment modality may free resources that could be reinvested to improve access to substance abuse treatment for a larger number of individuals in need of such treatment.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Mojtabai R,Zivin JGdoi
10.1111/1475-6773.00114keywords:
subject
Has Abstractpub_date
2003-02-01 00:00:00pages
233-59issue
1 Pt 1eissn
0017-9124issn
1475-6773journal_volume
38pub_type
杂志文章abstract：OBJECTIVE:To examine implementation of the Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) programs, enacted in 1988. The article summarizes the origin of the QMB and SLMB programs, describes what we have learned about QMB and SLMB enrollment in state Medicaid programs and, des...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2000-04-01 00:00:00
abstract：OBJECTIVE:To compare safety climate between diverse U.S. hospitals and Veterans Health Administration (VA) hospitals, and to explore the factors influencing climate in each setting. DATA SOURCES:Primary data from surveys of hospital personnel; secondary data from the American Hospital Association's 2004 Annual Survey ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2009.00994.x
更新日期：2009-10-01 00:00:00
abstract：OBJECTIVE:To develop and test predictive models of housing instability and homelessness based on responses to a brief screening instrument administered throughout the Veterans Health Administration (VHA). DATA SOURCES/STUDY SETTING:Electronic medical record data from 5.8 million Veterans who responded to the VHA's Hom...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13050
更新日期：2019-02-01 00:00:00
abstract：OBJECTIVES:(1) To examine the association of socioeconomic characteristics (SES) with hospitalization by age group, and when using measures of SES at the community as opposed to the individual level. (2) Thus, to support the inference that socioeconomic factors are important in the analysis of small area utilization da...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1998-06-01 00:00:00
abstract：OBJECTIVE:To determine if sufficient nurse staffing reduced in-hospital fractures in acute care hospitals. DATA SOURCES/STUDY SETTING:The Japanese Diagnosis Procedure Combination inpatient (DPC) database from July 2010 to March 2014 linked with the Surveys for Medical Institutions. STUDY DESIGN:We conducted a retrosp...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12529
更新日期：2017-06-01 00:00:00
abstract：:All admissions to a 1,100-bed Department of Veterans Affairs (VA) hospital were screened to identify 171 terminally ill patients with informal caregivers who were then randomly assigned to VA hospital-based team home care (HBHC, N = 85) or customary care (N = 86). Patient functioning, and patient and caregiver morale ...
journal_title：Health services research
pub_type： 临床试验,杂志文章,随机对照试验
doi：
更新日期：1992-02-01 00:00:00
abstract：OBJECTIVE:To simplify the decision-making process, we propose and implement an approach to assess the stability of health plan performance over time when multiple indicators of performance exist. DATA SOURCE:National Committee for Quality Assurance Health Care Effectiveness Data and Information Set data for childhood ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2008.00890.x
更新日期：2008-12-01 00:00:00
abstract：OBJECTIVE:To estimate the effects of competition for both Medicare and HMO patients on the quality decisions of hospitals in Southern California. DATA SOURCE:Secondary discharge data from the Office of Statewide Health Planning and Development for the State of California for the period 1989-1993. STUDY DESIGN:Outcome...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2003.00185.x
更新日期：2003-12-01 00:00:00
abstract：OBJECTIVES:Eight grant teams used Agency for Healthcare Research and Quality infrastructure development research grants to enhance the clinical content of and improve race/ethnicity identifiers in statewide all-payer hospital administrative databases. PRINCIPAL FINDINGS:Grantees faced common challenges, including recr...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12330
更新日期：2015-08-01 00:00:00
abstract：OBJECTIVE:To develop and test a new outcome measure, Conditional Length of Stay (CLOS), to assess hospital performance when deaths are rare and complication data are not available. DATA SOURCES:The 1991 and 1992 MedisGroups National Comparative Data Base. STUDY DESIGN:We use engineering reliability theory traditional...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1999-04-01 00:00:00
abstract：:A multitrait - multimethod design was employed to assess the construct validity of three commonly used methods for assessing patient compliance: physiological assessments (e.g., blood chemistries), ratings by health professionals, and patient self-reports. Subjects were patients receiving ambulatory hemodialysis treat...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1984-04-01 00:00:00
abstract：OBJECTIVE:To examine the influence of place of graduate medical education (GME), state licensure requirements, presence of established international medical graduates (IMGs), and ethnic communities on the initial practice location choices of new IMGs. DATA SOURCES:The annual Graduate Medical Education (GME) Survey of ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1034/j.1600-0560.2002.58.x
更新日期：2002-08-01 00:00:00
abstract：:A location model is used to determine the most efficient (i.e., least-cost) number and location of ambulance facilities in a rural area. The model incorporates response time and service time standards into the analysis and indicates the trade-off between costs and various time standards. The financial feasibility of i...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1977-10-01 00:00:00
abstract：OBJECTIVE:To examine the influence of dimensions of service quality on patient experience of primary care. DATA SOURCES/STUDY SETTING:Data from the national GP Patient Survey in England 2014/15, with responses from 858,351 patients registered at 7,918 practices. STUDY DESIGN:Expert panel and principal component analy...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12985
更新日期：2018-12-01 00:00:00
abstract：BACKGROUND:Patients are treated using observation services (OS) when their care needs exceed standard outpatient care (i.e., clinic or emergency department) but do not qualify for admission. Medicare and other private payers seek to limit this care setting to 48 hours. DATA SOURCE/STUDY SETTING:Healthcare Cost and Uti...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12143
更新日期：2014-06-01 00:00:00
abstract：OBJECTIVE:To examine concordance between member self-reports and the organization's administrative claims data for two key health factors: number of chronic conditions, and number of prescription drugs. DATA:Medicare Advantage plan claims data and member survey data from 2011 to 2012. DESIGN:Mailed surveys to 15,000 ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12356
更新日期：2016-06-01 00:00:00
abstract：OBJECTIVE:This article compares judgments about the treatment of Dukes' B2 and C colon cancer made by general surgeons to those of internists and family practitioners. Physician and practice variables were specialty, affiliation with a Community Clinical Oncology Program (CCOP) hospital, time in practice, professional ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1996-04-01 00:00:00
abstract：OBJECTIVE:To quantify the effects of informal caregiver availability and public funding on formal long-term care (LTC) expenditures in developed countries. DATA SOURCE/STUDY SETTING:Secondary data were acquired for 15 Organization for Economic Cooperation and Development (OECD) countries from 1970 to 2000. STUDY DESI...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2004.00328.x
更新日期：2004-12-01 00:00:00
abstract：OBJECTIVE:To compare estimates of health coverage from the pre- and post- redesign of the Current Population Survey (CPS) Annual Social and Economic Supplement. DATA SOURCES/STUDY SETTING:The CPS 2013 Content Test. STUDY DESIGN:A test of the old and new CPS in which the control panel was a subset of the CPS productio...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12312
更新日期：2016-02-01 00:00:00
abstract：:Arthroscopic surgery of the knee has reduced in-hospital utilization of 37 percent for surgical treatment of internal derangements of the knee at The Mount Sinai Medical Center. In a study comparing arthrotomies of the knee in 1974 (N = 106) to arthroscopic surgery of the knee in 1984 (N = 221) it was found that while...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1989-12-01 00:00:00
abstract：:We examined the expansion of Veterans Administration (now Department of Veterans Affairs--VA) inpatient psychiatric services from 1963 to 1984. Aggregate national trends in VA inpatient episodes between 1963 and 1984 document not only increased use of inpatient services but also "decentralization," or a shift to provi...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1990-04-01 00:00:00
abstract：:Using a sample of 3,000 urban hospitals, this article examines the contributions of selected hospital characteristics to variations in hospital technical efficiencies, while it accounts for multiple products and inputs, and controls for local environmental variations. Four hospital characteristics are examined: hospit...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1993-02-01 00:00:00
abstract：OBJECTIVE:We study the association between the timing of the Great Recession (GR) and health spending among uninsured adults distinguishing by citizenship/nativity status and time of U.S. residence. DATA SOURCE:Uninsured U.S. citizens and noncitizens from the 2005-2006 and 2008-2009 Medical Expenditure Panel Survey. ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12193
更新日期：2014-12-01 00:00:00
abstract：OBJECTIVE:To discuss and quantify the incentives that Medicare managed care plans have to avoid (through selective enrollment or disenrollment) people who are at risk for very high costs, focusing on Medicare beneficiaries in the last year of life-a group that accounts for more than one-quarter of Medicare's annual exp...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2004.00218.x
更新日期：2004-02-01 00:00:00
abstract：OBJECTIVE:To analyze differences in the determination of healthcare expenditures among racial/ethnic groups. DATA SOURCE:The 1987 National Medical Expenditure Survey, a nationally representative sample of the United States population. (Nomenclature reflects racial/ethnic categories as used in the Survey.) STUDY DESIG...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1998-10-01 00:00:00
abstract：OBJECTIVE:As part of a project to estimate physician requirements for the Department of Veterans Affairs, the Institute of Medicine (IOM) developed and tested empirically based models of physician staffing, by specialty, that could be applied to each VA facility. DATA SOURCE/STUDY SETTING:These analyses used selected ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1995-02-01 00:00:00
abstract：OBJECTIVE:To test the effects of state prescription contraception insurance mandates on unintended, mistimed, and unwanted births in a sample of privately insured recent mothers. DATA:We pooled Pregnancy Risk Assessment Monitoring System (PRAMS) data from 1997 to 2012 to study 209,964 privately insured recent mothers ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12792
更新日期：2017-12-01 00:00:00
abstract：OBJECTIVE:To explore and understand approaches to user engagement through investigating the range of ways in which health care workers and organizations accommodated the introduction of computerized physician order entry (CPOE) and computerized decision support (CDS) for hospital prescribing. STUDY SETTING:Six hospita...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12581
更新日期：2017-10-01 00:00:00
abstract：OBJECTIVE:To assess relationships between changes in Medicare Advantage (MA) payment rates and Medicare beneficiary hospitalizations and to simulate the effects of scheduled payment cuts on ambulatory care sensitive (ACS) and elective hospitalization rates. DATA:State Inpatient Database discharge abstracts from Arizon...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2011.01275.x
更新日期：2011-10-01 00:00:00
abstract：OBJECTIVE:To determine how the inclusion of post-acute evaluation and management (E&M) services as primary care affects assignment of Medicare beneficiaries to accountable care organizations (ACOs). DATA SOURCES:Medicare claims for a random 5 percent sample of 2009 Medicare beneficiaries linked to American Medical Ass...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12032
更新日期：2013-08-01 00:00:00
