Samuel Levey

Effectiveness of case management in substance abuse treatment.

Health officials have promoted case management as a promising intervention in substance abuse treatment (Ridgely & Willenbring, 1992). The relationship between organizational mission combined with case management and different types of outcomes has not been explored in studies, but they are worth noting and exploring further. This study, which is part of a larger clinical trial, examined the 3-, 6-, and 12-month effectiveness of case management in a residential setting for individuals treated for substance abuse. Clients who agreed to participate were randomly assigned to one of four study groups. Two groups received face-to-face case management and one telecommunication case management, while the fourth was the control group. Results from the analysis revealed only modest support for the effectiveness of case management as a supplement to traditional treatment. The face-to-face case-managed groups achieved improvements on the legal, employment, and psychiatric domains exceeding that achieved by the control group. Because of the short-term follow-up of the study, conclusive evidence of the effects of case management could not be drawn. This study is a valuable stepping stone, however, to further research in the field and as an aid to policymakers who are interested in knowing more about the effects of case management.

Cost-Effectiveness of Case Management in Substance Abuse Treatment

Objective: The purpose of this study, which is part of a larger clinical trial, was to examine the cost-effectiveness of case management for individuals treated for substance abuse in a residential setting. Method: Clients who agreed to participate were randomly assigned to one of four study groups. Two groups received face-to-face case management and one telecommunication case management, and the fourth was the control group. Results: Using a ratio of cost to days free from substance abuse, the case management groups were less cost-effective than the control group at 3 months, 6 months, and 12 months. The telecommunication case management was least cost-effective of the three case management conditions. Conclusion: Results from the analysis revealed case management is not cost-effective as a supplement to traditional drug treatment over a 12-month follow-up period.

Governing board, C-suite, and clinical management perceptions of quality and safety structures, processes, and priorities in U.S. hospitals.

EXECUTIVE SUMMARY To achieve quality improvement in hospitals requires greater attention to systems thinking than is typical at this time, including a shared understanding across different levels of the hospital of the current state of quality improvement efforts. A self‐administered survey assessed the perceptions of board members, C‐suite executives, and clinical managers regarding quality activities and structures. This instrument, the Hospital Leadership and Quality Assessment Tool (HLQAT), includes 13 domains in six conceptual areas that we believe are major organizational drivers of quality and safety: (1) commitment of senior leaders, (2) a vision of exemplary quality, (3) a supportive culture, (4) accountable leadership, (5) appropriate organizational structures, and (6) adaptive capability. HLQAT survey results from a convenience sample of more than 300 hospitals were linked to performance on the Centers for Medicare & Medicaid Services (CMS) Core Measures. The results show significantly different perceptions between the groups. Higher HLQAT scores for each respondent group were associated with better hospital performance on the CMS Core Measures. There is no magic bullet—no one domain dominates. Leaders in higher‐performing hospitals appear to be more effective at conveying their vision of quality care and creating a culture that supports an expectation that staff and leadership will work across traditional boundaries to improve quality.

Strategic Planning for Long-Term Care

Strategic governmental planning in the long-term care sector is necessary because services provided are often inefficient, inaccessible, and of questionable quality. New approaches must address difficult problems, such as design of agencies, selection of appropriate planning methodologies, and balance of institutional and community-based care, all of which are pervaded by important value considerations and conflicts.

Determinants of Small-Area Variation in Hospital Utilization The Evidence from Hospital Discharge Abstracts

Small-area differences in hospital use were examined using hospital discharge abstract data for the populations of seven small service areas in Iowa that exhibited substantial variation in admission rates during 1980. The results indicate a marked difference in the age composition of the patient populations with older patients being more common among residents of high-use areas, higher age- and sex-adjusted discharge rates per 1000 in the high-use areas across many diagnostic categories, frequently higher average lengths of stay in high-use areas, a lack of conformity between discharge patterns for selected surgical procedures and diagnoses, and more readmissions to the same hospital during a 12-month period for residents of high-use areas. This data set comprises one part of a study of small-area differences that also employed household surveys, physician surveys, and other existing data sets. The findings illustrate the potential and limitations of hospital discharge abstracts as a data base for evaluating hospital discharge abstracts as a data base for evaluating hospital utilization differentials.Small-area differences in hospital use were examined using hospitaldischarge abstract data for the populations of seven small service areas in Iowa that exhibited substantial variation in admission rates during 1980. The results indicate (1) a marked difference in the age composition of the patient populations with older patients being more common among residents of high-use areas, (2) higher ageand sexadjusted discharge rates per 1000 in the high-use areas across many diagnostic categories, (3) frequently higher average lengths of stay in high-use areas, (4) a lack of conformity between discharge patterns for selected surgical procedures and diagnoses, and (5) more readmissions to the same hospital during a 12-month period for residents of high-use areas. This data set comprises one part of a study of smallarea differences that also employed household surveys, physician surveys, and other existing data sets. The findings illustrate the potential and limitations of hospital discharge abstracts as a data base for evaluating hospital discharge abstracts as a data base for evaluating hospital utilization differentials.