title: Toward cost-effective staffing mixes for Veterans Affairs substance use disorder treatment programs.
abstract: BACKGROUND
  In fiscal year (FY) 2008, 133,658 patients were provided services within substance use disorders treatment programs (SUDTPs) in the U.S. Department of Veterans Affairs (VA) health care system. To improve the effectiveness and cost-effectiveness of SUDTPs, we analyze the impacts of staffing mix on the benefits and costs of specialty SUD services. This study demonstrates how cost-effective staffing mixes for each type of VA SUDTPs can be defined empirically.
  
  
  METHODS
  We used a stepwise method to derive prediction functions for benefits and costs based on patients' treatment outcomes at VA SUDTPs nationally from 2001 to 2003, and used them to formulate optimization problems to determine recommended staffing mixes that maximize net benefits per patient for four types of SUDTPs by using the solver function with the Generalized Reduced Gradient algorithm in Microsoft Excel 2010 while conforming to limits of current practice. We conducted sensitivity analyses by varying the baseline severity of addiction problems between lower (2.5 %) and higher (97.5 %) values derived from bootstrapping.
  
  
  CONCLUSIONS
  Compared to the actual staffing mixes in FY01-FY03, the recommended staffing mixes would lower treatment costs while improving patients' outcomes, and improved net benefits are estimated from $1472 to $17,743 per patient.
authors.affiliation: Management of Innovation Program, Daegu Gyeongbuk Institute of Science and Technology, Daegu, 711-873, South Korea. jinwoo.im@dgist.ac.kr.|Department of Management Science and Engineering, Stanford University, Stanford, CA, 94305, USA. jinwoo.im@dgist.ac.kr.|Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park, CA, 94025, USA. jinwoo.im@dgist.ac.kr.
authors.forename: Jinwoo J
authors.initials: JJ
authors.lastname: Im
authors.affiliation: Department of Management Science and Engineering, Stanford University, Stanford, CA, 94305, USA. shachter@stanford.edu.
authors.forename: Ross D
authors.initials: RD
authors.lastname: Shachter
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park, CA, 94025, USA. John.Finney@va.gov.
authors.forename: John W
authors.initials: JW
authors.lastname: Finney
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Healthcare System, Menlo Park, CA, 94025, USA. Jodie.Trafton@va.gov.|Department of Psychiatry and Behavioral Sciences and Center for Health Policy, Stanford University School of Medicine, 795 Willow Road (152-MPD), Stanford, CA, 94305, USA. Jodie.Trafton@va.gov.
authors.forename: Jodie A
authors.initials: JA
authors.lastname: Trafton
mesh_terms: D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006282:Health Personnel / Q000191:economics*; D006787:Hospitals, Veterans / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D019966:Substance-Related Disorders / Q000191:economics* / Q000534:rehabilitation; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs / Q000191:economics; D014728:Veterans / Q000706:statistics & numerical data