Use of Performance Based Contracts in Outpatient Substance Abuse Treatment

基于绩效的合同在门诊药物滥用治疗中的使用

• 批准号: 7332069
• 负责人: Maureen T Stewart
• 金额: $ 2.62万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-11-01 至 2009-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7332069
• 关键词: Accounting; Address; Affect; Alcohol abuse; Alcohols; Area; Caring; Characteristics; Client; Cluster Analysis; Contracts; Data; Delaware; Drug Abuse Treatment Services; Drug abuse; Economics; Effectiveness; Evaluation; Future; Goals; Health Personnel; Health Services Research; Incentives; Institute of Medicine (U.S.); Lead; Literature; Measures; Medical; Methods; Modeling; NIH Program Announcements; National Institute of Drug Abuse; Outpatients; Performance; Pharmaceutical Preparations; Policies; Policy Maker; Prevention; Probability; Process; Public Health; Publishing; Rate; Recommendation; Regression Analysis; Reporting; Research; Research Institute; Services; Severities; Substance abuse problem; Surveys; System; Techniques; Testing; Time; Work; base; behavioral health; cost; design; improved; multilevel analysis; payment; programs; response; size; treatment organization

DESCRIPTION (provided by applicant): A recent NIDA Health Services Research Program Announcement (PA) called for studies of the ways in which payment mechanisms "affect the degree of access to, and delivery, utilization, and quality of prevention and treatment services for drug abuse or alcohol abuse". The PA specifically called for evaluations of performance contracting models, as proposed in this study. Despite recommendations from the Institute of Medicine, little published exists on the impact of performance contracting on quality of general medical or behavioral health care. One of the first performance based contracts (PBC) for substance abuse (SA) treatment was implemented in Delaware in 2001. The goals of this project are to improve our understanding of how PBC works and how it impacts quality of SA treatment. Results of this study will provide valuable information which will inform current and future use of performance based contracting in SA treatment and in other areas. This study will use administrative data and a facility survey to: 1) Analyze whether the PBC program met its' goals of improving facility occupancy, client active participation in treatment and completion of treatment by analyzing the change in these contracted performance measures overtime, controlling for client characteristics. 2) Analyze the impact of facility characteristics such as the proportion of revenue from public clients, size of the organization and target of incentives, on the change in the probability of clients meeting the active participation criteria over time, controlling for client severity. 3) Determine whether and how SA treatment organizations responded to the change from a cost based contract to a performance based payment system. This study employs a quasi- experimental pre-post design. While all hypotheses will be tested using quantitative methods, a facility survey will be conducted to provide additional context and detail necessary to understand the impact of the PBC and facilities' responses to the PBC. Information obtained through the survey will allow for a more complete description of the PBC. All regression analyses will be conducted using multilevel modeling techniques to account for clustering of clients within facilities. These techniques are an increasingly popular method for analysis of clustered data. The proposed research will provide valuable information for policy makers and SA treatment providers as performance based contracts continue to develop. This study will improve public health by exploring the impact of quality improvement initiatives for substance abuse treatment.

描述（由申请人提供）：最近的 NIDA 卫生服务研究计划公告 (PA) 呼吁研究支付机制“影响药物预防和治疗服务的获取程度、交付、利用和质量”的方式滥用或酗酒”。正如本研究中所提议的，PA 特别呼吁对绩效承包模式进行评估。尽管医学研究所提出了建议，但关于绩效合同对一般医疗或行为保健质量的影响的出版物却很少。第一个基于绩效的药物滥用 (SA) 治疗合同 (PBC) 于 2001 年在特拉华州实施。该项目的目标是提高我们对 PBC 工作原理及其如何影响 SA 治疗质量的了解。这项研究的结果将提供有价值的信息，为当前和未来在 SA 治疗和其他领域使用基于绩效的合同提供信息。本研究将使用管理数据和设施调查来： 1) 通过分析这些合同绩效指标随时间的变化、控制客户特征。 2) 分析设施特征（例如来自公共客户的收入比例、组织规模和激励目标）对客户满足积极参与标准的概率随时间变化的影响，并控制客户严重性。 3) 确定 SA 治疗组织是否以及如何应对从基于成本的合同到基于绩效的支付系统的变化。本研究采用准实验前后设计。虽然所有假设都将使用定量方法进行检验，但仍将进行设施调查，以提供了解 PBC 的影响以及设施对 PBC 的反应所需的额外背景和细节。通过调查获得的信息将有助于对 PBC 进行更完整的描述。所有回归分析都将使用多级建模技术进行，以考虑设施内客户的聚类情况。这些技术是一种越来越流行的聚类数据分析方法。随着基于绩效的合同的不断发展，拟议的研究将为政策制定者和 SA 治疗提供者提供有价值的信息。这项研究将通过探索药物滥用治疗质量改进举措的影响来改善公众健康。