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Section E

Section E. Inside the Black Box of Integrated Care: Intensity and Mix of Clinical and Coordination Services. Jerry Flanzer (NIDA) For co-author James Bell, James Bell Associates. About ISRs. About 25,000 Intervention Service Records (ISR) were generated by providers.

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Section E

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  1. Section E Inside the Black Box of Integrated Care: Intensity and Mix of Clinical and Coordination Services Jerry Flanzer (NIDA) For co-author James Bell, James Bell Associates

  2. About ISRs • About 25,000 Intervention Service Records (ISR) were generated by providers. • ISRs afford an unprecedented ability to examine multiple aspects of integrated care at the individual case level. • Multi-Level quality assurance approach: -- Data collection forms customized to employ terminology used by local invention staff -- Well-documented definitions and data collection procedures -- Training including challenging case/encounter simulations and remedial exercises -- Study site supervisory QA review (100%) -- Coordinating Center QA review (100%) -- Double data entry (100%) -- Automated logical error checks -- Analysis testing (currently underway)

  3. Major ISR Service Categories -- Clinical - therapeutic interventions provided by mental health/substance abuse clinicians with advanced degrees in health professions and appropriate licenses/certifications. -- Care Management - supportive and counseling services delivered by health and social services providers with an undergraduate degree or less formal education including peer counselors. -- Case Management - traditional case management. -- Internal Coordination - case-specific collaboration among providers within the intervention. -- External Coordination - case-specific collaboration between providers inside the intervention and providers outside the intervention. -- Outreach/Engagement – activities undertaken to find clients and promote/enable service use. -- Referral - intervention provider-recommended, client-executed use of an outside service.

  4. Commonly Used ISR Clinical Services Subcategories

  5. Basic ISR Descriptive Statistics • Number of cases ranged from 42 in Site A to 133 in Site C • Total service units (all cases) ranged from 4,312 in Site E to 17,686 in Site B • Mean service units per case ranged from 64.6 for Site C to 135.0 for Site B • Within Site range of service units per case varied from a low of 229 in Site E to 546 in Site B • Mean service minutes per case ranged from 1144 in Site E to 3896 in Site A - Percentage of minutes per case with client present ranged from 70 percent (Site D) to 86 percent (Site C) .

  6. Basic ISR Descriptive Statistics by Selected Site

  7. Distribution of Service Units by Service Category • Clinical services and care management together accounted for between 14 percent and 43 percent of service units. - Overall, the distribution of service units among categories indicates a strong reliance on management and coordination services that seem necessary to respond to patients’ complex biopsychosocial needs.

  8. Percentage of Service Units by Site and Major Service Category

  9. Change on Selected Outcomes Measures by Site • Sites B and C registered significant improvements in physical health, mental health and alcohol severity scores. • Sites D and A showed significant improvement on two or one of these outcomes, respectively. • No Site registered significant improvement on drug severity score. • Site E did not show significant improvements on the four outcomes selected for preliminary analysis.

  10. Significant Positive Changes on Selected Outcomes by Site *p = <.0025 **p = <.0001

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