Clinical trial NCT00012727: Matching, Outcomes and Costs in Substance Abuse/Psychiatric Treatment
Official title: Matching, Outcomes and Costs in Substance Abuse/Psychiatric Treatment
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE2
Conditions: Dual Diagnosis
Lead sponsor: VA Office of Research and Development
Sponsor class: FED
First posted: 2001-03-16
Enrollment: 236
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This project�s goal is to improve the quality of care and reduce treatment costs for veterans with substance abuse and psychiatric problems.

Detailed description: Background:

This project�s goal is to improve the quality of care and reduce treatment costs for veterans with substance abuse and psychiatric problems.

Objectives:

This project is evaluating a patient-treatment matching strategy to improve 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 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 treatment should prove to be more cost-effective than hospital treatment.

Methods:

The project utilized a stratified randomized design. We paired each of three VA hospital 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 also paired four VA hospital and four CRFs that are low on intensity. Veterans who applied for substance abuse treatment at VA facilities were randomly assigned to either the VA hospital or CRF. Patient assessments have been conducted at intake (N=230), discharge, and a 4-month follow-up. 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.

Status:

Completed.

Eligibility criteria: Inclusion Criteria:

Patients must be entering a VA inpatient substance abuse or psychiatric treatment program and be clinically judged as appropriate for inpatient or community residential care.

Exclusion Criteria:

Primary outcomes:
Secondary outcomes:
Other outcomes:
Locations:
city: Long Beach
country: United States
facility: VA Long Beach Healthcare System, Long Beach, CA
state: California
city: Palo Alto
country: United States
facility: VA Palo Alto Health Care System, Palo Alto, CA
state: California
city: Gainesville
country: United States
facility: North Florida/South Georgia Veterans Health System, Gainesville, FL
state: Florida
city: Omaha
country: United States
facility: Omaha VA Nebraska-Western Iowa Health Care System, Omaha, NE
state: Nebraska
city: Oklahoma City
country: United States
facility: Oklahoma City VA Medical Center, Oklahoma City, OK
state: Oklahoma
city: Hampton
country: United States
facility: Hampton VA Medical Center, Hampton, VA
state: Virginia
Study officials:
affiliation: VA Palo Alto Health Care System, Palo Alto, CA
name: Christine Timko, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Timko C, Sempel JM, Moos RH. Models of standard and intensive outpatient care in substance abuse and psychiatric treatment. Adm Policy Ment Health. 2003 May;30(5):417-36. doi: 10.1023/a:1024693614501.
citation: Timko C, Sempel JM. Short-term outcomes of matching dual diagnosis patients' symptom severity to treatment intensity. J Subst Abuse Treat. 2004 Apr;26(3):209-18. doi: 10.1016/S0740-5472(04)00002-9.
citation: Timko C, Lesar M, Calvi NJ, Moos RH. Trends in acute mental health care: comparing psychiatric and substance abuse treatment programs. J Behav Health Serv Res. 2003 Apr-Jun;30(2):145-60. doi: 10.1007/BF02289804.
citation: Timko C, Lesar M, Engelbrekt M, Moos RH. Changes in services and structure in community residential treatment facilities for substance abuse patients. Psychiatr Serv. 2000 Apr;51(4):494-8. doi: 10.1176/appi.ps.51.4.494.
citation: Timko C, Sempel JM. Intensity of acute services, self-help attendance and one-year outcomes among dual diagnosis patients. J Stud Alcohol. 2004 Mar;65(2):274-82. doi: 10.15288/jsa.2004.65.274.
citation: Chen S, Barnett PG, Sempel JM, Timko C. Outcomes and costs of matching the intensity of dual-diagnosis treatment to patients' symptom severity. J Subst Abuse Treat. 2006 Jul;31(1):95-105. doi: 10.1016/j.jsat.2006.03.015.
citation: Timko C, Yu K, Moos RH. Demand characteristics of residential substance abuse treatment programs. J Subst Abuse. 2000;12(4):387-403. doi: 10.1016/s0899-3289(01)00056-6.