Improving Continuity of Care in a Public Addiction Treatment System with Clinical Case Management

Abstract

Philadelphia attempted to expand the access to and continuity of addiction treatment by focusing on the 15% of patients who received multiple, detoxification-only (MDO) treatments each year. Clinical Case Managers at five detoxification centers encouraged MDO patients to continue care following detoxification in methadone, residential, or outpatient rehabilitation, and sustain improvements, and they recommended opening detoxification access for additional patients as well. System administrative information was available for one year prior and three years during the intervention. Counts of unduplicated patients within each year and measures of the length and type of treatment episodes determined the intervention effects. Records from a sub-sample of 100 MDO patients were examined to assess specific changes in system utilization. Over three years, 890 MDO patients were case managed and had received assessment, referral, and transport to health care and sober living. The sub-sample of case-managed MDO patients showed a 55% reduction in detoxification-only admissions, a 70% increase in use of rehabilitation, and a twenty-day increase in the average length of stay per episode. Though there are noted limitations in the evaluation design, the findings are consistent with the view that individual case management of MDO patients may improve the clinical appropriateness and administrative efficiency of public addiction treatment.

Evidence-Based Treatments of Addiction

“…This is not logical, but it is a fact of the current health-care system in the USA (McLellan et al 2005). Detoxification is actually performed by the patient's own metabolic processes.…”

Does gender-specific substance abuse treatment for women promote continuity of care?

“…and others(McLellan, Weinstein, Shen, Kendig, & Levine, 2005; TOPPS-II Interstate Cooperative Study Group, 2003). 2 This requirement was used to ensure that a continuing care episode reflected a planned and intended transfer rather than the onset of a new episode of care.…”

Reprise: Case Management in Substance Use Services in the Age of the Affordable Care Act

“…Perhaps motivated by the mixed results presented in outcome studies of substance use services, some have called for the development of more comprehensive programs (Evenson, Binner, Cho, Schicht, & Topolski, 1998;Humphreys & Tucker, 2002;Institute of Medicine, 1990;McLellan, Weinstein, Shen, Kendig, & Levine, 2005). This quest is motivated by a number of factors.…”