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HSR&D 2004 National Meeting Abstracts

1068. Coordination and Substance Use Disorder Patients' Continuing Care Outcomes
Jeanne A Schaefer, , Center for Health Care Evaluation, VA Palo Alto Healthcare System, R Cronkite, Center for Health Care Evaluation, VA Palo Alto Healthcare System, E Ingudomnukul, Center for Health Care Evaluation, VA Palo Alto Healthcare System

Objectives: Coordination, a key aspect of continuity of care, may contribute to substance use disorder (SUD) patientsí engagement in continuing outpatient care. We examined whether coordination was related to (1) SUD patientsí engagement in continuing care, (2) the duration of their continuing care episode, and (3) consistency of their participation in continuing care.

Methods: Counselors for 835 patients in 28 VA intensive SUD programs provided data on five practices they used to coordinate patientsí care. The VA OPC File provided data on patientsí continuing care outcomes, i.e., a SUD clinic visit within a month of discharge, number of consecutive months with at least one SUD visit, and number of consecutive months with two or more SUD visits within 6 months of discharge.

Results: Outpatient programs provided more coordination than inpatient/residential programs and coordination resulted in better outcomes in outpatient programs. Patients engaged in continuing care, remained in continuing care longer, and participated more consistently in it when staff reviewed patientsí discharge summaries with outpatient counselors. Practices such as jointly developing discharge plans and notifying counselors of patientsí impending discharge were related to greater retention in continuing care and consistency of participation. Receipt of an outpatient appointment, prior SUD/psychiatric visits, fewer alcohol problems, and higher motivation also were associated with better outcomes. Findings did not hold for inpatient/residential programs.

Conclusions: Coordination is related to better patient outcomes in outpatient programs, but not in inpatient/residential programs.

Impact: Outpatient program intervention studies are needed to determine coordination practices that best facilitate patientsí engagement in continuing care.