BACKGROUND/RATIONALE:
Beginning in the mid-1990's, VA treatment services for substance use disorders shifted from a predominantly inpatient location to a predominantly outpatient location. With this move, a wide variety of new and modified outpatient treatment programs have been developed, with variations in length, intensity, and in program characteristics. We know very little about how outpatient substance use treatment intervenes in the trajectory of service use of veterans with substance use disorders, or how associated health care costs are affected. Our study is the first in the VA to investigate overall service utilization, costs, and cost-offsets associated with variations in outpatient substance use treatment.

OBJECTIVE(S):
Our objectives are: 1) to identify patient characteristics associated with variations and patterns of medical, psychiatric, and substance use service use before and after outpatient substance use treatment; 2) to identify the association between extent/duration of treatment received and variations in service use before and after outpatient substance use treatment (more specifically, we are grouping patients empirically by duration/frequency of treatment received, including a comparison group identified as having substance use disorders but receiving no substance use treatment in the index year); 3) to identify program characteristics associated with variations and patterns of service use before and after outpatient substance use treatment; and 4) to investigate the presence of cost-offsets associated with outpatient substance use treatment, by treatment groups, patient characteristics, and program characteristics.

METHODS:
This project uses a pre/post quasi-experimental design. Cohorts of veterans receiving outpatient treatment for substance use disorder have been identified (intensive outpatient, traditional outpatient, and opiate substitution). Service utilization data and patient-level characteristics are derived from the Patient Treatment File (PTF) and OPC file, and cost estimates of inpatient days, outpatient clinic visits, surgical procedures, and alternative housing will be generated from the Decision Support System
(DSS). Treatment program data (for FY99 only) are derived from a Drug and Alcohol Program Survey (DAPS-- project directed by Co-Investigator Dr. Humphreys). Veterans are grouped according to treatment status--e.g., completed treatment, incomplete treatment, and "no treatment" (i.e., patients with a diagnosis of substance use disorder identified in the course of care for another illness and not treated on substance use units/clinics). Dependent variables are the change in numbers of inpatient days/outpatient stops between the pre- and post-treatment periods. Cost estimates for inpatient days, outpatient stops, surgical procedures, and housing will be used to generate cost change scores. Multiple regression analyses and hierarchical linear models will be used to assess the impact of treatment group and both patient- and organizational-level variables on service use and cost changes.

FINDINGS/RESULTS:
We have been performing our core analyses of service use and cost offset associated with receiving substance use treatment. We are performing these analyses on cohorts of patients from intensive outpatient treatment and opiate substitution therapy. We have completed several analyses pertaining to detection of substance use disorders in primary care and attrition from substance use treatment.

IMPACT:
Our results will provide important information to VA policymakers and service providers regarding cost and service use outcomes of the shift to outpatient substance use treatment.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Stecker T, Han X, Curran GM, Booth BM. Characteristics of women seeking intensive outpatient substance use treatment in the VA. Journal of women's health. 2007 Dec 1; 16(10):1478-84. [view]
2. Curran GM, Stecker T, Han X, Booth BM. Individual and program predictors of attrition from VA substance use treatment. The journal of behavioral health services & research. 2009 Jan 1; 36(1):25-34. [view]
3. Stecker T, Curran GM, Han X, Booth BM. Patterns of health services use associated with Veterans Affairs outpatient substance-use treatment. Journal of Studies On Alcohol. 2007 Jul 1; 68(4):510-8. [view]
4. Mancino M, Curran G, Han X, Allee E, Humphreys K, Booth BM. Predictors of attrition from a national sample of methadone maintenance patients. The American journal of drug and alcohol abuse. 2010 May 1; 36(3):155-60. [view]

Conference Presentations

1. Curran G. ER use amount patients with comorbid substance abuse and psychiatric disorders. Paper presented at: National Institute on Drug Abuse Research in Practice Annual Conference; 2001 Jun 1; Little Rock, AR. [view]

DRA: Health Systems, Substance Use Disorders
DRE: Epidemiology
Keywords: Organizational issues, Outpatient
MeSH Terms: Alcoholism