Coordinating Primary Care and
Substance Abuse Treatment Services
Presented at:
Academy Health Annual Conference
Boston, Massachusetts
Deborah Gurewich,, PhD
Donald Shepard, PhD
Jenna Sirkin, MA
Galina Zolotusky, MA
Jeffrey Prottas, PhD
Deborah Garnick, PhD
Schneider Institutes for Health Policy, Brandeis University
June 28, 2010
Funded by the Robert Wood Johnson Foundation Substance Abuse Policy and Research Program (SAPRP)
1
Study Aims
1. Determine how community health centers
((CHCs)) coordinate pprimary
y care and
substance abuse treatment (SAT) services
2 Identify most effective approaches for
2.
coordinating primary care and SAT services
3. Understand the practices associated with
especially effective coordination models
2
Background
• Medical services located in SAT facilities effective but not
widely diffused1
– How to translate evidence to practice not well understood
– Need to identify useful and feasible alternate models
• CHCs may offer
ff useful
f l lessons
l
– History of pioneering efforts to improve coordination
– Most offer SAT services but scope and delivery modes vary3
– Patients with SA disorders fastest growing CHC patient group4
1Umbricht-Schneiter
2Proser
P
& Cox,
C
2004
3Druss et al., 2006
3
et al., 1994; Friedmann et al., 1999
Framework
• Theoretical continuum of efficiency1
– Diffused models
– Centralized models
• Systems
S t
needed
d d to
t coordinate
di t services
i 2
– Boundary spanning staff (e.g., case managers)
– Information systems (e.g., HIT, conferencing)
1D’Aunno,
1997
2 Druss & von Esenwein 2006
4
Data
• Mail survey
– Describe SAT services offered and delivery mode
– CHCs in three states (CA, MA and TX)
– 85% response rate (N=155)
• Administrative claims
– Medicaid Analytic
y Extract data files ((2002-2004))
– Beneficiaries with SA disorders whose usual source of care
was study CHC
– N = 15,000 observations (exclude TX due to small sample)
5
Analysis
• D
Descriptive
i ti analysis
l i off survey responses
• Multivariate claims-based analysis
– Dependent variables:
 WC-HEDIS Initiation and Engagement measures
 Only patients identified on outpatient claims
– Independent variables:
 SAT service
i model:
d l scope, type andd delivery
d li
mode
d
 Covariates: demographics, case mix, state
– Adjust for clustering by patient and site
6
Services Offered
100%
91% 93%
92%
95%
90%
Percentt of CHC
Cs
80%
74%
77%
73%
76%
70%
60%
50%
Alcohol
Drugs
40%
30%
20%
10%
2% 3%
0%
No Services
7
Screening &
Diagnosis
Therapy &
Counseling
Intensive
Outpatient
Detoxification
Services Offered On SIte
60%
Percent oof CHCs
50%
49%
51%
51%
48%
40%
Alcohol
Drugs
30%
20%
16%
13%
8% 7%
10%
0%
No services
8
Screening &
Intensive Outpatient
Outpatient Therapy
Detoxification
Initiation Regression Models
9
Engagement Regression Models
10
Descriptives
11
Summary
• CHCs engaged
d in
i SAT service
i delivery
d li
• Better care qqualityy associated with:
– IOP on site in CA (opposite effect in MA)
– Non
Non-whites
whites, non
non-disabled
disabled and younger patients
• MA associated with lower quality than CA
• No
N effect
ff associated
i d with:
ih
– On-site screening and/or therapy and counseling
– Service scope
12
Implications
• Service approach may be sensitive to delivery
system
y
in which provider
p
operates
p
• Case studies (final phase) aim to understand:
– Ob
Observedd state
t t differences
diff
– CHC organizational decision-making
– Systems that coordinate services in both diffused
and centralized models
13
Thank You
14