title: Reducing readmissions to detoxification: an interorganizational network perspective.
abstract: BACKGROUND
  The high cost of detoxification (detox) services and health risks associated with continued substance abuse make readmission to detox an important indicator of poor performance for substance use disorder treatment systems. This study examined the extent to which the structure of local networks available to detox programs affects patients' odds of readmission to detox within 1 year.
  
  
  METHODS
  Administrative data from 32 counties in California in 2008-2009 were used to map network ties between programs based on patient transfers. Social network analysis was employed to measure structural features of detox program networks. Contextual predictors included efficiency (proportion of ties within a network that are non-redundant) and out-degree (number of outgoing ties to other programs). A binary mixed model was used to predict the odds of readmission among detox patients in residential (non-hospital) facilities (N=18,278).
  
  
  RESULTS
  After adjusting for patient-level covariates and continuity of service from detox to outpatient or residential treatment, network efficiency was associated with lower odds of readmission.
  
  
  CONCLUSIONS
  The impact of network structure on detox readmissions suggests that the interorganizational context in which detox programs operate may be important for improving continuity of service within substance use disorder treatment systems. Implications for future research are discussed.
authors: University of Southern California, School of Social Work, USA. Electronic address: spearse@usc.edu.
authors: Suzanne E
authors: SE
authors: Spear
mesh_terms: D000293:Adolescent; D000328:Adult; D019058:Community Networks / Q000458:organization & administration* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends; D010360:Patient Transfer / Q000458:organization & administration* / Q000639:trends; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult
keywords: Coordination of care; Detoxification; Multilevel modeling; Network analysis