@article{ref1,
title="Identifying optimal level-of-care placement decisions for adolescent substance use treatment",
journal="Drug and alcohol dependence",
year="2020",
author="Agniel, Denis and Almirall, Daniel and Burkhart, Q. and Grant, Sean and Hunter, Sarah B. and Pedersen, Eric R. and Ramchand, Rajeev and Griffin, Beth Ann",
volume="212",
number="",
pages="e107991-e107991",
abstract="BACKGROUND: Adolescents respond differentially to substance use treatment based on their individual needs and goals. Providers may benefit from guidance (via decision rules) for personalizing aspects of treatment, such as level-of-care (LOC) placements, like choosing between outpatient or inpatient care. The field lacks an empirically-supported foundation to inform the development of an adaptive LOC-placement protocol. This work begins to build the evidence base for adaptive protocols by estimating them from a large observational dataset. <br><br>METHODS: We estimated two-stage LOC-placement protocols adapted to individual adolescent characteristics collected from the Global Appraisal of Individual Needs assessment tool (n = 10,131 adolescents). We used a modified version of Q-learning, a regression-based method for estimating personalized treatment rules over time, to estimate four protocols, each targeting a potentially distinct treatment goal: one primary outcome (a composite of ten positive treatment outcomes) and three secondary (substance frequency, substance problems, and emotional problems). We compared the adaptive protocols to non-adaptive protocols using an independent dataset. <br><br>RESULTS: Intensive outpatient was recommended for all adolescents at intake for the primary outcome, while low-risk adolescents were recommended for no further treatment at followup while higher-risk patients were recommended to inpatient. Our adaptive protocols outperformed static protocols by an average of 0.4 standard deviations (95 % confidence interval 0.2-0.6) of the primary outcome. <br><br>CONCLUSIONS: Adaptive protocols provide a simple one-to-one guide between adolescents' needs and recommended treatment which can be used as decision support for clinicians making LOC-placement decisions.<br><br>Copyright © 2020 Elsevier B.V. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0376-8716",
doi="10.1016/j.drugalcdep.2020.107991",
url="http://dx.doi.org/10.1016/j.drugalcdep.2020.107991"
}