title: Treatment staff's continuity of care practices, patients' engagement in continuing care, and abstinence following outpatient substance-use disorder treatment.
abstract: OBJECTIVE
  Although speculation suggests that continuity of care predicts abstinence following substance-use disorder (SUD) treatment, models examining staff's continuity of care practices and engagement in continuing care and whether they mediate or moderate the association between patient and treatment factors and abstinence are lacking. In this study, we aimed to model abstinence using combinations of independent pretreatment and treatment factors, discharge continuity of care practices, and posttreatment engagement and to identify mediators or moderators of relationships between these factors and abstinence.
  
  
  METHODS
  Staff in 18 Department of Veterans Affairs (VA) outpatient SUD programs used the Addiction Severity Index to assess 429 nonabstinent patients' alcohol and drug problems at treatment entry. Staff supplied discharge data on patients' motivation, treatment intensity and completion, and continuity of care practices. Administrative data assessed patients' continuing care engagement. A 6-month follow-up, the Addiction Severity Index assessed abstinence. Mixed-effects logistic regression models were used to examine predictors of abstinence.
  
  
  RESULTS
  Abstinence occurred more when discharge plans specified at least one continuing care appointment per week, patients received continuing care appointments before discharge, and staff provided patients drug-free/sober living arrangements and with longer engagement in continuing care. SUD/psychiatric clinic use before treatment entry, treatment completion, access to transportation for continuing care appointments, and more patient motivation for continuing care also predicted abstinence. Engagement in continuing care mediated the relationship between continuity of care and abstinence and between SUD/psychiatric clinic use and abstinence.
  
  
  CONCLUSIONS
  Findings suggest that continuity of care practices influence abstinence mostly through their effect on patients' engagement in continuing care.
authors.affiliation: Center for Health Care Evaluation, Department of Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152), Menlo Park, California 94025, USA. Jeanne.Schaefer@va.gov
authors.forename: Jeanne A
authors.initials: JA
authors.lastname: Schaefer
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Cronkite
authors.forename: Patricia
authors.initials: P
authors.lastname: Turrubiartes
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011787:Quality of Health Care; D012720:Severity of Illness Index; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration* / Q000592:standards; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs