Short-term outcomes of matching dual diagnosis patients' symptom severity to treatment intensity.
This study evaluated a patient-treatment matching strategy intended to improve the effectiveness of hospital-inpatient and community-residential treatment for dual diagnosis patients. Matching variables were the severity of patient disorders and the program's service intensity. Each of three high-intensity hospital programs was paired with a nearby high-intensity community program; there were also four low-intensity pairs. Patients (N=230) were randomly assigned to hospital or community care at intake, and followed at discharge (96%) and at 4 months (90%). Support was found for the matching strategy at discharge in that severely ill patients treated in high-intensity programs improved more on substance abuse outcomes, and moderately ill patients treated in low-intensity programs improved more on psychiatric outcomes. The benefits of matching held at 4 months in that high-severity patients had better alcohol outcomes when they were treated in high-rather than low-intensity programs. High-and moderate-severity patients did not show differential outcomes in hospital-based or community-based programs. Dual diagnosis patients should be matched by symptom severity with program service intensity, but matching with hospital or community care may not enhance treatment outcomes.
Timko
Christine
C
Center for Health Care Evaluation, Department of Veterans Affairs Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA. ctimko@stanford.edu
Sempel
Jill M
JM
D000704:Analysis of Variance; D003156:Community Mental Health Services; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000534:rehabilitation*; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods*; D012017:Referral and Consultation; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000534:rehabilitation*; D014728:Veterans