Despite the rapid growth of managed care, our knowledge of its application and impact on alcoholism treatment/service patterns and the effectiveness of treatment is lacking. The purpose of this study is to begin to examine the relationships among client characteristics and behaviors; the setting, duration, intensity, and format of treatment (i.e., treatment/service patterns); and outcomes under different managed care arrangements. The proposed study has the following aims:
Aim #1, characterize commonly observed treatment/service patterns, including the receipt of services in multiple settings (e.g., a brief inpatient stay followed by intensive outpatient treatment) among a sample of clients treated for alcohol abuse;
Aim #2, identify the key clinical characteristics of clients that are related to different treatment/service patterns and determine what differences exist across managed care arrangements in the settings, duration, intensity, and format of treatment received;
and Aim #3, assess outcomes across different treatment/service patterns using two posttreatment followup interviews, one at 3 months post-discharge and a second at 12 months. The study sample will be selected from alcohol-abusing clients (N=1400) receiving treatment at two major treatment programs and whose health care coverage involves managed care. The study will involve six manage care entities representing both private and public payors. Subjects will be interviewed at admission to obtain background information and baseline behaviors and data will also be gathered from treatment programs on insurance benefits, care authorized by the managed care entity, and the patterns of treatment/services received Two followup interviews will be conducted (one at 3 months post-discharge and a second at 12 months). The analyses will address the three aims of the study. Identification of treatment/service patterns will be based on both combinations of treatment settings and the amount of therapeutic contact. Univariate and multivariate comparisons of pretreatment characteristics and behaviors will be made among clients from different payor/managed care arrangements and treatment/service patterns. Finally, outcomes will be assessed across different treatment/service patterns using multivariate models, controlling for client characteristics and baseline behaviors. The primary outcome measures will be days of abstinence from alcohol and total quantity of alcohol consumed. Findings from the project will be important to providers and payors as both seek to provide the most effective form of treatment for alcohol abuse at the least cost.
