Improving Drug Abuse Treatment Planning Criteria: This K-24 Mid- Career Investigator Award will provide an intense phase of career development and mentoring in drug abuse health services research. The research goal is to develop criteria for determining treatment quality and appropriateness, parameters that become increasingly important as clinical management changes focus on cost reduction to cost-effectiveness.
The specific aims are to apply the ASAM PPC algorithms to 4 additional data sets that complement the ASAM Study sample, to extend our knowledge of the 1) concurrent validity and 2) predictive validity of the ASAM PPC and 3) to improve it. These cohorts include: non-treatment seekers, outpatient treatment seekers, hospitalized liver transplant candidates and opiate anesthesia detoxification candidates. This is an efficient opportunity to study all levels of care described by the ASAM Criteria, without the cost/effort of devising controlled, prospective trials. The hypotheses are that the ASAM PPC: H1) will show baseline between-group differences that are useful for disease staging, H2) will demonstrate predictive validity for clinical and utilization outcomes, and H3) will yield some dimensional constructs, decision rules and scoring thresholds that do not initially meet validity criteria but, with revision and iterative re-analysis, can achieve significance. The results will facilitate future controlled trials via RO1 applications. The Mentoring Plan will focus on Post-residency Fellows in Addiction Psychiatry (3 per year), and also incorporate post- doctoral trainees in health services research and dissertation students in health policy. Mentoring will occur through trainees' participation in the research projects that are planned in each of the four naturalistic convenience samples (for whom complete data are already gathered or are substantially underway). Validation work is required for each of the 6 ASAM PPC assessment dimensions, for each level of care, and within sub-populations. This range of research needs offers a rich matrix of opportunities for a group of trainees and junior investigators in patient-oriented research. Over the next five years, the candidate seeks to: a) move to full-time effort in research and research mentoring, b) increase the depth of his own skills in psychometrics, health economics and data analysis through specific trainings, c) increase his ability to incorporate advanced modeling approaches through collaborations with statistical and health economics experts, and to d) increase his efforts at dissemination, both through publication of results in the scientific literature and through a generation of junior investigators who will acquire the fascination and skills to advance this new area of patient- oriented research.
