Addiction Services Guide - Articles

It is intended as a blueprint that will provide guidance to the National Institute on Alcohol Abuse and Alcoholism in the continued development of its research program in this important field. This document summarizes that report.This national plan was prepared by the Subcommittee on Health Services Research for the National Advisory Council on Alcohol Abuse and Alcoholism at a time of both critical need and substantial opportunity in health services research. Health care delivery is undergoing profound and rapid change in both its organizational structure and its financing arrangements. These changes are occurring in response to the complex demands of containing costs, maintaining the quality of care, making care available to all who need treatment, and focusing resources on those forms of care that offer the best hope of successful outcomes. How these changes will affect treatment for people with alcohol dependence (including the effectiveness of care, its quality, its utilization, and its costs) are issues of great importance to researchers and policymakers alike. The National Institute on Alcohol Abuse and Alcoholism has both an opportunity and an obligation to promote state-of-the-art research on these topics. This report provides a comprehensive plan, informed by the latest scientific findings, that identifies the key areas of future research inquiry. The Subcommittee identified a number of priority areas. First among these is the study of the effects of managed care on the access, utilization, quality, costs, and outcomes of USA alcohol treatment services. Understanding the diverse set of practices known as managed care and their full range of consequences on the alcohol treatment system was the most common concern that emerged during the course of the Subcommittee's work. A key task in studying the effects of managed care is to increase our understanding of the alcohol treatment system and its many parts. This includes the interactive processes between patients, providers, government agencies, those who pay for treatment services, and those who act as financial intermediaries in the delivery of care. The study of managed care also focuses on the sets of risks and incentives that impinge on all parties involved. Understanding how these risks and incentives operate, and their consequences for the access, utilization, quality, costs, and outcomes of care, are key objectives in the study of the organization and financing of the treatment system. A second priority area is the study of outcomes as they relate to costs. As organizational and financial changes occur, incentives and pressures are created which favor the delivery of certain forms of treatment at the expense of others. This raises the following critical questions: What are the differences in treatment outcomes that can be expected from changes in the content of treatment or the form of its delivery? and What changes in treatment costs and cost-effectiveness will occur? Another priority identified by the Subcommittee is to make continued investments toward improving methodology. Therefore, an integral part of any program to improve alcohol health services research must be the standardization of measures and the development of data collection systems for monitoring and analyzing trends in utilization, client characteristics, costs, insurance coverage, clinical status, and treatment outcomes. Equally important is the application of appropriate research designs to meet the unique challenges involved in conducting quality research in everyday practice settings. The recommendations presented in this report were developed through an intensive process that reflects a significant effort on the part of many people whom we wish to thank. First of all, the 29 leading researchers and providers who agreed to write the commissioned background papers on which the Subcommittee's work is based. Next, the 41 experts who agreed to serve as panel members under the direction of panel chairs Nancy Day, Ph.D., Harold Holder, Ph.D., and Willard Manning, Ph.D. We have been assisted throughout this process by NIAAA staff Gregory Bloss, M.A., Richard K. Fuller, M.D., Michael Hilton, Ph.D., Robert B. Huebner, Ph.D., Harold I. Perl, Ph.D., and Stephen W. Long. Thanks to all of them for their efforts. A special note of thanks is due to Michael Hilton, Ph.D. and Robert B. Huebner, Ph.D. for serving as the authors of this report and to Sarah Brookhart for serving as report editor. Also, I would like to thank Mark W. Lipsey, Ph.D., for his contributions on the topic of research synthesis. Finally, as Chair, I would like to thank especially the members of this Subcommittee, most of whom also served on one of the panels, who have patiently and thoughtfully guided this project to its final completion. All have rendered their services from a desire to promote continued excellence in the development of the Institute and its research program.

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