Enhancing NIDA’s Health Services Research

1. Enhancing NIDA’s Health Services Research Wilson M. Compton, M.D., M.P.E. Director Division of Epidemiology, Services and Prevention Research National Institute on Drug Abuse National Institutes of Health Department of Health and Human Services

2. NIDA National Institute on Drug Abuse Office of the Director Nora D. Volkow, MD Director Director, AIDS Research Special Populations Office Timothy P. Condon, Ph.D. Deputy Director Health Services Research at NIDA Laura S. Rosenthal EEO Associate Director for Management Office of Extramural Affairs Office of Planning & Resource Management Office of Science Policy & Communications Center for the Clinical Trials Network Teresa Levitin, PhD Laura Rosenthal Timothy Condon, PhD Betty Tai, PhD Division of Pharmacotherapies & Medical Consequences of Drug Abuse Division of Clinical Neuroscience, Development & Behavioral Treatment Division of Epidemiology, Services & Prevention Research Division of Basic Neurosciences & Behavior Research Intramural Research Program David Shurtleff, PhD Frank Vocci, PhD Wilson Compton, MD, MPE Joseph Frascella, PhD Barry Hoffer, MD, PhD

3. NIDA Blue Ribbon Task Force on Health Services Research Co-Chairs: Thomas McLellan, PhD, Constance Weisner, DrPH, MSW Andrea Barthwell, MD Caryn Blitz, PhD Rick Catalano, PhD Mady Chalk, PhD Linda Chinnia, MEd Lorraine Collins, PhD Wilson Compton, MD, MPE Michael Dennis, PhD Richard Frank, PhD Warren Hewitt, MS James Inciardi, PhD Marguerita Lightfoot, PhD Isaac Montoya, PhD Claire Sterk, PhD Janet Wood, MBA, MEd

4. Rec #1: Defining Health Services Research A multidisciplinary field that examines how: social factors, financing systems, organizational structures and processes, health technologies, and personal beliefs and behaviors access to and utilization of healthcare, quality and cost of healthcare, and our health and well-being. affect Ultimately, the goals of health services research are to identify the most effective ways to organize, manage, finance, and deliver high quality care.

5. Rec #2: Enhance Practices Through Research on Organization, Management, and Economic Issues

6. Prison-Based Drug Abuse Treatment Can Be Cost Effective Higher cost for addiction treatment: $7,041 for the Amity group v. $1,731 for control. BUT markedly less incarceration costs: 81 fewer incarceration days among Amity participants relative to controls-a cost-effectiveness ratio of $65 per dollar invested. McCollister et al. Justice Quarterly 2004

7. Higher Costs AND Better Outcomes = Cost Effective Integrated Care for SAMC Patients Incremental C/E Ratio ($2,605-$2,369) -------------------- = $1,581 (.70-.55) Weisner C, et al. JAMA 2001;286(14):1715-1723.

8. Aftercare is Cost Effective McCollister, et al. (2003), Journal Quantitative Criminology

9. Drug Courts Can Result in Economic Benefits • Cost-Benefit Analysis 3 KY Drug Courts • Cost-Benefit Results for Graduates • Every $1 spent resulted in return of $3.83 economic benefit • Net Economic Benefit $14,526 Logan, et al., 2004

10. Innovation: A function of “Absorptive Capacity” Absorptive Capacity Indicators: • environmental scanning (journals, workshops, etc.) • monitoring patient satisfaction • professionalism (number of: master’s level/licensed/certified therapists, physicians, persons in recovery)

11. Rec #3: Evaluate Causal Associations

12. Braiding Funding Streams • Adolescent Services Including Brief Interventions (FY2003 with SAMHSA) • Assessment and Brief Interventions in Primary Care (FY2004 with SAMHSA) • NIDA Funding Research on CSAP’s National SPF-SIG Program (FY2004) • Service to Science Grants (with SAMHSA) for State Substance Abuse Authorities (FY2005) and Community Based Organizations (FY2006)

13. CTN Sites Research Centers Coordinating Center National Drug Abuse Treatment Clinical Trials Network (CTN) Criminal Justice Drug Abuse Treatment Studies (CJ-DATS)

14. “Atypical” Withdrawal Predicts Relapse and Requires Rethinking of Tobacco Services 1.9 1.7 1.5 1.3 WITHDRAWAL SEVERITY 1.1 0.9 0.7 Cluster I (N=71) Cluster II ( N=31) Cluster III (N=122) 0.5 0 10 20 30 40 50 60 DAY From: Piasecki, Fiore & Baker, 1998

15. A multidisciplinary field that examines how: Definition: social factors, financing systems, organizational structures and processes, health technologies, and personal beliefs and behaviors access to and utilization of healthcare, quality and cost of healthcare, and our health and well-being. affect Major Challenge: Build and Test Theories How does this empirical definition help develop theory and the underlying science?

16. Potential Theories • Transtheoretical Stages of Change • Diffusion Theory • Anderson and Aday Model • Organization and Management Theories • Behavioral Economics • Chronic Illness Models (Theory?) • Possible Neuroscience Models?

17. Major Opportunities • Revised Services PA released by NIDA and NIAAA jointly, PA-05-139 • Community Based Care RFA, DA-06-001, DUE December 19 • “Charting a course for health services research at the National Institute on Drug Abuse”JSAT 2005; 29:167-172

18. Summary • Flat NIH/NIDA budget encourages innovative use of existing resources • Networks such as CTN/CJ-DATS • Secondary analysis • How do we “take interventions to scale”? – A Major Challenge! • Perhaps we can enhance the science of services research by linking findings within theoretical frameworks.