Incentives in Public Addiction Treatment: Testing Design and Enhancing Impact

公共戒瘾治疗的激励措施：测试设计并增强影响力

• 批准号: 8538925
• 负责人: SHARON REIF
• 金额: $ 42.26万
• 依托单位: BRANDEIS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-01 至 2017-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8538925
• 关键词: Address; Affect; Area; Boxing; Caring; Client; Collaborations; Contracts; Data; Development; Drug Controls; Drug abuse; Effectiveness; Ensure; Environment; Evaluation; Funding; Generations; Goals; Grant; Group Meetings; Health Personnel; Healthcare; Home environment; Incentives; Indium; Institute of Medicine (U.S.); Institutes; Interview; Laboratories; Link; Literature; Maine; Measures; Medicaid; Medical; Medicare; Modeling; Modification; Outcome; Outpatients; Performance; Policies; Prevalence; Process Measure; Quality of Care; Randomized; Research; Research Design; Rewards; Role; Services; Specific qualifier value; Strategic Planning; Structure; Substance Use Disorder; Substance abuse problem; Surveys; System; Techniques; Testing; Time; United States Substance Abuse and Mental Health Services Administration; Work; addiction; base; behavioral health; care systems; clinical practice; control trial; design; financial incentive; improved; innovation; meetings; multilevel analysis; novel strategies; outreach; payment; programs; randomized trial; response; stem; treatment program

DESCRIPTION (provided by applicant): Innovative ways are needed to improve quality of treatment for substance use disorders (SUDs), since it can be effective but is not always successful. Performance-based contracting (PBC) aims to align treatment program incentives and purchaser goals to drive high-quality care, yet is uncommon in drug abuse treatment systems. Because improvements will require changes by programs, clinicians and staff, it may be beneficial to incentivize these groups to work together. Design features are paramount in the effectiveness of P4P, yet few controlled trials of different incentive designs have been conducted and open questions remain on particular design features that contribute to effective systems. In 2007, Maine implemented a 2nd-generation PBC system with financial incentives for outpatient programs that receive federal block grant funding. Using Maine as a laboratory, we go beyond evaluation of an SUD treatment PBC to focus on unintended effects and outcomes; test a payment design that rewards clinicians/front-line staff for program performance by sending quarterly checks directly to clinicians/staff whose program meets their targets; and delve into response to incentives by both programs and clinicians, to understand how treatment programs and clinicians adapt organizational, management and clinical practices due to such incentives. The proposed study, conducted in collaboration with Maine's Office of Substance Abuse, will use administrative data and data collected from program interviews and clinician/staff surveys, incorporating multilevel modeling and a difference-in-difference approach. PBC is a significant change in payment design and may affect how SUD treatment services are delivered. As prevalence of PBC and other forms of P4P continue to increase, it is critical to understand how programs respond to PBC initiatives. This ability to focus on the "black box" of response to incentives is a unique and innovative aspect of the proposed study. Aims 1 and 2 use retrospective data from the ongoing Maine PBC that began in 2007. For Aims 3 and 4, we overlay a new approach to how incentives are distributed at a program level and examine this with a randomized design. Specifically, we aim to: 1. Determine if the PBC improved the rewarded measures of access and retention and determine what, if any, positive or negative unintended effects stemmed from the PBC. 2. Examine how client outcomes were affected by the PBC, controlling for adverse selection if identified, and determine associated organizational factors. 3. Test in a randomized trial at the program level whether the addition of clinician group incentives, paid directly to clinicians and front-line staff to reward overall program performance as defined by the PBC, improves program performance. 4. Determine what changes, if any, are implemented by programs (e.g., quality improvement initiatives) or by clinicians (e.g., outreach to clients) after introduction of incentives.

描述（由申请人提供）：需要创新的方法来改善物质使用障碍的治疗质量（SUDS），因为它可以有效，但并不总是成功。基于绩效的合同（PBC）旨在使治疗计划的激励措施和购买者目标保持高质量的护理，但在药物滥用治疗系统中并不常见。由于改进需要计划，临床医生和员工的更改，因此激励这些群体共同努力可能是有益的。设计功能对于P4P的有效性至关重要，但很少进行不同激励设计的对照试验，并且在有效系统的特定设计功能上仍然存在开放问题。 2007年，缅因州实施了第二代PBC系统，并为获得联邦块资助的门诊计划提供了经济激励措施。使用缅因州作为实验室，我们超越了对SUD治疗PBC的评估，专注于意想不到的效果和结果；测试付款设计，通过将季度支票直接发送给计划符合目标的临床医生/员工，从而奖励临床医生/前线员工进行计划绩效；并深入研究计划和临床医生的激励措施，以了解治疗计划和临床医生如何由于这种激励措施而适应组织，管理和临床实践。拟议的研究与缅因州的药物滥用办公室合作，将使用计划访谈和临床医生/员工调查收集的行政数据和数据，并结合了多级建模和差异差异方法。 PBC是付款设计的重大变化，可能会影响SUD治疗服务的交付方式。随着PBC和其他形式的P4P的患病率继续增加，了解计划如何应对PBC计划，这一点至关重要。这种专注于激励措施的“黑匣子”的能力是拟议研究的独特而创新的方面。 AIMS 1和2使用从2007年开始的缅因州PBC的回顾性数据。对于Aims 3和4，我们覆盖了一种新的方法，可以将激励措施在程序级别分配并使用随机设计进行检查。具体来说，我们的目的是：1。确定PBC是否改善了访问和保留的奖励度量，并确定源于PBC的阳性或负面意外影响（如果有的话）。 2。检查客户结果如何受到PBC的影响，控制不良选择，并确定相关的组织因素。 3。在计划级别的随机试验中测试是否添加 临床医生团体激励措施直接支付给临床医生和一线员工，以奖励PBC定义的整体计划表现，可提高计划的绩效。 4.确定在引入激励措施后，通过计划（例如，质量改进计划）或临床医生（例如向客户推广）实施的变化（如果有）。