| Learning Objective #1: Describe the elements of a model of dosage for case management | |||
| Learning Objective #2: Discuss the results of a test of the elements of case management dosage |
Purpose: Because of the broad range of activities involved and the high variance in clients’ needs, it is challenging to measure the actual dose of case management in order to assess quality and manage outcomes. Yet the financial constraints of health care will no longer sustain the practice of continuing to give sweeping treatments to everyone without evidence for effectiveness. The purpose of this research is to describe the measurement of the dosage of a case management intervention and evaluate its impact on outcomes in substance abuse treatment. Methods: A longitudinal randomized clinical trial research project served as the basis for measuring and evaluating the dosage of case management in substance abuse treatment. Using an investigator-derived conceptual model, the four dimensions of the dosage of an intervention are amount, frequency, duration, and breadth. Lacking guidance in the literature, the researchers constructed measures of each of the four dimensions and tested them with a sample of 598 adult clients in substance abuse treatment who were randomized into one of four groups and followed for 12 months. Results: The constructed measures were reasonable and feasible to capture in a computerized information system. Linear regressions with Addictions Severity Index (ASI) (McLellan et al., 1992) composite scores as dependent variables demonstrated significant relationships for both family and legal issues. Proportional hazards regression analysis demonstrated that on any given day the odds of terminating case management were 33% lower in the outside agency case management condition and 43% higher in the telecommunications condition. Patterns were significantly different among dose elements, having implications for staffing, workload, deployment, and outcomes. Implications: Measuring dose of a behavioral intervention helps to compare interventions, assure fidelity, and manage outcomes.
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