System Stability: The Role of Treatment Program Size and Performance on Closure

Abstract

Little is known about the stability of the substance use treatment service system to provide consistent care. Guided by organizational theories, we examined whether program size (number of admissions) and performance (treatment access, retention, and completion) is associated with program closure. This study relied on multiyear administrative data of 249,029 treatment admission episodes from 475 treatment programs in the Los Angeles County system between 2006 and 2014. Findings from survival analysis show partial support for most hypotheses - program size and retention rates were negatively associated with risk of closure. Compared to residential treatment services, outpatient services were positively associated with risk of closure. Contrary to what we expected, having a higher proportion of Medicaid-eligible clients was associated with risk of closure. The closure of smaller and strategically located outpatient programs in minority communities has significant implications for population health and reducing health disparities. Implications for theory development and health care management practices to support delivery of quality care are discussed.