Analyzing staffing and care practices to improve substance use outcomes in VA patients
Abstract/Contents
- Abstract
- Using U.S. Department of Veterans Affairs (VA) records, this dissertation explores the staffing mix in substance use disorder treatment programs (SUDTPs) and the effectiveness of the current clinical practice guideline in reducing suicide risk associated with opioid therapy. The VA treats a large number of Veterans diagnosed with substance use disorders (SUDs) in four types of specialized SUDTPs at an annual cost of more than $350 million. The staffing mixes were not significantly different from 2001 to 2003, the years under review. However, given differences in treatment focus and provided services, the four types of SUDTPs may require different staffing mixes. We demonstrate how cost-effective staffing mixes for each type of VA SUDTP can be defined empirically. We derive prediction functions for benefits and costs based on patients' treatment outcomes at VA SUDTPs nationally from 2001 to 2003, and use them to formulate optimization problems to determine recommended staffing mixes that maximize net benefits per patient for four types of SUDTPs while conforming to limits of current practice. Compared to the actual staffing mixes in 2001-2003, the recommended staffing mixes would lower treatment costs while improving patient outcomes. We also introduce an approach to building a decision support system for staffing each type of SUDTP reflecting the dynamics of effectiveness and costs associated with the staffing changes. Compared to the actual staffing mixes, the staffing mixes suggested by the staffing decision support system are expected to treat significantly more Veteran patients under the existing staffing budget while improving patient outcomes. We also examine associations between adherence to guideline recommendations and the risk of suicide attempt based on Veterans Health Administration (VHA) records. Opioid therapy is often provided to reduce chronic pain in at-risk patients. Unfortunately, available opioid medications have been also used as a means for attempting suicide. In 2010, the VHA and the Department of Defense released a jointly developed clinical practice guideline (CPG) to reduce the risk of adverse events such as suicide attempt in patients prescribed opioids, primarily based on expert consensus. We conduct multivariate mixed-effects logistic regression analyses to define the associations between facility-level CPG adherence rates and risk of suicide attempt while controlling for the associations between individual-level delivery of CPG-based services and the risk of suicide attempt. Major findings include the following: suicide attempts were negatively associated with facility-level adherence rates for both consistent urine drug screenings and follow-up appointments, and were positively associated with facility-level risky sedative co-prescription rates.
Description
| Type of resource | text |
|---|---|
| Form | electronic; electronic resource; remote |
| Extent | 1 online resource. |
| Publication date | 2013 |
| Issuance | monographic |
| Language | English |
Creators/Contributors
| Associated with | Im, Jin Woo |
|---|---|
| Associated with | Stanford University, Department of Management Science and Engineering |
| Primary advisor | Shachter, Ross D |
| Thesis advisor | Shachter, Ross D |
| Thesis advisor | Brandeau, Margaret L |
| Thesis advisor | Trafton, Jodie A |
| Advisor | Brandeau, Margaret L |
| Advisor | Trafton, Jodie A |
Subjects
| Genre | Theses |
|---|
Bibliographic information
| Statement of responsibility | Jin Woo Im. |
|---|---|
| Note | Submitted to the Department of Management Science and Engineering. |
| Thesis | Thesis (Ph.D.)--Stanford University, 2013. |
| Location | electronic resource |
Access conditions
- Copyright
- © 2013 by Jin Woo Im
- License
- This work is licensed under a Creative Commons Attribution Non Commercial 3.0 Unported license (CC BY-NC).
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