Correlates of Patient-Centered Care Practices at U.S. Substance Use Disorder Clinics
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Dependent Variables
Explanatory Variables
Health care reform.
Organizational characteristics.
Leadership attributes.
Staff and client characteristics.
Control variables.
Analytic Approach
Results
Descriptive Statistics
Patients invited to participate | ||||||||
---|---|---|---|---|---|---|---|---|
Yes (N=139) | No (N=454) | |||||||
Variable | N | % | N | % | N | % | Fa | p |
Dependent | ||||||||
Invite patients to participate in clinical decision-making processes | 139 | 23 | ||||||
Patient-centered care factor score (M±SD)b | –.1±.9 | .1±.9 | –.1±.9 | 6.5 | .011 | |||
Explanatory and control | ||||||||
Located in Medicaid expansion state | 472 | 70 | 102 | 70 | 325 | 69 | .1 | .783 |
Total N of substance abuse admissions in county (thousands) (M±SD)c | 14.0±22.6 | 15.5±24.0 | 13.1±21.9 | 1.2 | .282 | |||
Percentage of revenue from private and commercial insurance (M±SD) | 15.5±23.6 | 15.0±24.1 | 16.6±24.2 | .4 | .547 | |||
Service modality | ||||||||
Outpatient opioid treatment program | 213 | 8 | 45 | 9 | 155 | 9 | .0 | .946 |
Outpatient nonopioid treatment program | 290 | 66 | 48 | 52 | 209 | 71 | 17.6 | <.001 |
Inpatient clinic | 46 | 4 | 11 | 4 | 27 | 4 | .2 | .690 |
Residential clinic | 108 | 21 | 35 | 35 | 63 | 17 | 22.4 | <.001 |
Ownership | ||||||||
Private for profit | 162 | 30 | 39 | 28 | 115 | 32 | .5 | .462 |
Private nonprofit | 358 | 57 | 71 | 57 | 262 | 55 | 2.3 | .132 |
Public | 90 | 13 | 21 | 15 | 66 | 13 | .3 | .619 |
Owned by hospital or mental health facility | 152 | 25 | 31 | 24 | 109 | 23 | .0 | .834 |
Accountable care organization or patient-centered medical home in place | 150 | 22 | 34 | 31 | 106 | 21 | 5.1 | .025 |
Accredited (JC or CARF)d | 377 | 53 | 88 | 59 | 269 | 52 | 1.8 | .183 |
Director perceived high competition | 372 | 60 | 78 | 61 | 260 | 57 | .6 | .448 |
Directors’ reliance on professional information sources (M±SD)e | 3.4±.7 | 3.4±.7 | 3.4±.7 | .0 | .915 | |||
Clinical supervisor endorsed 12-step treatment model | 328 | 56 | 76 | 60 | 246 | 53 | 1.9 | .172 |
Percentage of staff with medical training (M.D. or R.N.) (M±SD) | 7.3±12.6 | 7.8±13.0 | 6.6±12.2 | .9 | .354 | |||
Percentage of staff in recovery from substance use disorder (M±SD) | 33.3±29.5 | 34.5±27.1 | 33.7±29.8 | .1 | .810 | |||
Percentage of patients with alcohol use disorder (M±SD) | 49.7±26.8 | 44.6±29.3 | 51.4±26.1 | 6.0 | .014 | |||
Percentage of patients with opioid use disorder (M±SD) | 32.7±32.4 | 31.7±28.5 | 33.0±33.1 | .2 | .679 | |||
Percentage of patients with prescription opioid use disorder (M±SD) | 27.6±25.4 | 28.5±26.6 | 27.6±25.2 | .1 | .738 | |||
Percentage of involuntary patients (M±SD) | 46.1±34.8 | 50.4±34.0 | 44.4±34.8 | 3.0 | .083 | |||
Percentage of patients from racial-ethnic minority groups (M±SD) | 39.5±31.1 | 50.0±35.0 | 35.8±29.0 | 21.4 | <.001 | |||
Region | ||||||||
Northeast | 182 | 21 | 33 | 18 | 131 | 22 | .2 | .649 |
Midwest | 159 | 23 | 36 | 26 | 106 | 23 | .6 | .422 |
South | 176 | 29 | 37 | 26 | 120 | 30 | .1 | .814 |
West | 140 | 27 | 33 | 30 | 97 | 25 | 1.2 | .271 |
N of staff (full- and part-time) (M±SD) | 21.7±36.9 | 22.7±53.4 | 32.6±32.6 | .1 | .783 |
Regression Analysis
Patients invited to participate in clinical decision-making processes | Patient-centered care factor score | |||||
---|---|---|---|---|---|---|
Variable | OR | 95% CI | p | Coef | 95% CI | p |
Located in Medicaid expansion state (reference: not) | 1.43 | .78 to 2.62 | .245 | –.13 | –.34 to .08 | .230 |
Total N of substance abuse admissions in countya | .93 | .79 to 1.08 | .333 | .01 | –.04 to .07 | .598 |
Percentage of revenue from private and commercial insuranceb | .91 | .70 to 1.17 | .445 | .07 | –.01 to .16 | .082 |
Service modality (reference: outpatient nonopioid treatment program) | ||||||
Outpatient opioid treatment program | 1.32 | .69 to 2.52 | .405 | .20 | –.02 to .43 | .080 |
Inpatient clinic | 2.54 | .94 to 6.89 | .067 | .04 | –.33 to .42 | .818 |
Residential clinic | 3.42 | 1.80 to 6.51 | <.001 | .14 | –.10 to .39 | .249 |
Ownership (reference: private for-profit) | ||||||
Private nonprofit | .60 | .35 to 1.02 | .061 | –.08 | –.27 to .12 | .434 |
Public | .77 | .38 to 1.56 | .476 | –.18 | –.44 to .08 | .174 |
Owned by hospital or mental health facility | 1.03 | .59 to 1.80 | .913 | –.05 | –.25 to .14 | .590 |
Accountable care organization or patient-centered medical home in place (reference: no) | 1.25 | .76 to 2.05 | .388 | –.02 | –.21 to .16 | .794 |
Accredited (JC or CARF) (reference: not accredited)c | 1.42 | .86 to 2.34 | .167 | –.07 | –.25 to .12 | .477 |
Director perceived high competition (reference: not perceived) | 1.06 | .68 to 1.64 | .797 | –.18 | –.34 to –.02 | .025 |
Director’s reliance on professional information sources | .85 | .62 to 1.15 | .288 | .19 | .08 to .31 | ≤.001 |
Clinical supervisor endorsed 12-step treatment model (reference: did not endorse) | .99 | .63 to 1.56 | .972 | .03 | –.13 to .20 | .684 |
Percentage of staff with medical training (M.D. or R.N.)b | .99 | .77 to 1.28 | .941 | –.02 | –.11 to .07 | .687 |
Percentage of staff in recovery from substance use disorderb | .91 | .71 to 1.17 | .476 | –.09 | –.19 to .01 | .070 |
Percentage of patients with alcohol use disorderb | .77 | .60.99 | .040 | .04 | .05 to .12 | .433 |
Percentage of patients with opioid use disorderb | .74 | .57 to .96 | .025 | –.02 | –.11 to .08 | .733 |
Percentage of patients with prescription opioid use disorderb | 1.19 | .90 to 1.56 | .218 | .05 | –.05 to .15 | .334 |
Percentage of involuntary patientsb | 1.14 | .87 to 1.48 | .343 | .02 | –.07 to .12 | .611 |
Percentage of patients from racial-ethnic minority groupsb | 1.48 | 1.18 to 1.86 | <.001 | –.03 | –.11 to .05 | .480 |
Region (reference: Northeast) | ||||||
Midwest | 1.46 | .79 to 2.69 | .230 | –.20 | –.42 to .02 | .080 |
South | 1.02 | .48 to 2.15 | .964 | –.18 | –.44 to .08 | .177 |
West | 1.14 | .61 to 2.15 | .673 | –.18 | –.41 to .04 | .115 |
N of staff (full- or part-time)a | .95 | .75 to 1.22 | .706 | .04 | –.05 to .12 | .424 |
Patient-centered care factor score | 1.27 | 1.00 to 1.62 | .048 | |||
Invite patients to participate in clinical decision-making processes | .19 | .01 to .36 | .042 |
Discussion
Findings
Limitations
Conclusions
Acknowledgments
Supplementary Material
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