Substance Abuse Treatment System Improvement: Geographically Enabled Perspectives
Delving into the intersection of accessibility and the operational aspects of opioid treatment programs, particularly within the diverse urban landscape of Los Angeles County. The projects shed light on the impacts of commuting time to treatment facilities, service continuity in public drug treatment systems, and the patterns of client choices , revealing key insights for policy formulations and healthcare system optimization.
Where do Clients Receive Methadone Treatment? Disparities in Driving Times, Choice of Facilities, and Treatment Plan CompletionPublished in Substance Use: Research & Treatment (link)
Guest Lecturer at University of Chicago Center For Health Administration Autumn 2022 Michael M. Davis Lecture Series - Watch here
The study investigates where clients receive methadone treatment for opioid use disorder (OUD) in relation to their residence
While travel time to treatment can impact care access, there's anecdotal evidence that clients often don't choose the nearest methadone providers, though concrete bypass rates are not well-documented.
The research delves into: (1) bypassing patterns over time and geography among methadone treatment clients in Los Angeles County, (2) variations in bypassing based on gender and ethnoracial backgrounds, and (3) the relationship between client bypassing and characteristics of both the nearest and chosen treatment facilities.
Using a retrospective approach, the study analyzed OUD treatment data from 2010 to 2017, involving 16,972 outpatient methadone treatment episodes in LAC, and matched them with estimated commute times from Google Maps.
The analysis, which included 32 methadone treatment facilities and 8,627 distinct clients, used driving time differences between the nearest and chosen providers to determine bypass rates and examined these rates across different demographic groups and facility characteristics.
The results highlight significant bypass rates affecting efficient access. The findings hold implications for opioid treatment system design, advocating improved access to quality providers for underserved communities
Stability in a Large Drug Treatment System: Examining the Role of Program Size and Performance on Service DiscontinuationWith Erick Guerrero, Daniel Howard, Shinyi Wu, and Thomas D’Aunno
Published in the International Journal of Drug Policy and presented at Academy of Management 2018
The study delves into the stability of public drug treatment in the U.S. during a period of public insurance expansion, focusing on the influence of program size and performance on service discontinuation.
Drawing from organizational theories, the research analyzed data from 2006-2014, encompassing 249,029 treatment admission episodes across 482 programs in Los Angeles County, CA.
Survival regression analysis was employed to determine the relationships between program size, treatment initiation (measured by wait time), engagement (measured by retention and completion rates), and the likelihood of discontinuing services.
Findings revealed that 62% of programs ceased services at some point between 2006 and 2014. Larger program size and higher treatment retention rates were linked to a decreased risk of service discontinuation. Additionally, a higher proportion of female clients and being a methadone program were associated with reduced discontinuation risks.
Interactions between program size and retention rates, as well as program size and completion rates, were found to be significant, with both combinations showing a reduced risk of service discontinuation.
The study underscores the importance of supporting smaller programs (which make up over 70% of the system) to ensure sustained services and address disparities in care access. The findings have significant implications for system evaluation and public health crisis response.
Disparities in Expected Driving Time to Opioid Treatment and Treatment Completion: Findings from an Exploratory StudyPublished in BMC Health Services Research and presented at Addiction Health Services Research Conference 2021 (Top Rated Abstract). Watch here
The study investigates how commuting time to treatment impacts outcomes, specifically focusing on driving time to opioid programs and its effects on treatment results.
Using discharge survey data from 22,587 outpatient opioid treatment episodes in Los Angeles County, the study estimated driving times to treatment facilities using Google Maps.
Multivariable logistic regressions were employed to explore the relationship between estimated driving time and the likelihood of treatment completion, accounting for potential confounding factors.
Results revealed an average driving time of 11.32 minutes and an average distance of 11.18 km. Notable disparities in driving times were observed across age, gender, education level, and Medi-Cal eligibility, with younger, male, more educated, and Medi-Cal-ineligible clients typically driving longer distances.
A driving time exceeding 10 minutes was linked to a 33% decrease in methadone treatment plan completion. These findings can guide decisions on the optimal geographic positioning of methadone treatment facilities and future service expansion strategies.