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）：需要创新的方法来提高物质使用障碍（SUD）的治疗质量，因为它可能有效，但并不总是成功。基于绩效的合同 (PBC) 旨在协调治疗计划激励措施和购买者目标，以推动高质量护理，但这在药物滥用治疗系统中并不常见。由于改进需要项目、临床医生和工作人员做出改变，因此激励这些群体共同努力可能是有益的。设计特征对于 P4P 的有效性至关重要，但对不同激励设计的对照试验很少进行，并且对于有助于有效系统的特定设计特征仍然存在悬而未决的问题。 2007 年，缅因州实施了第二代 PBC 系统，为接受联邦整笔拨款资助的门诊项目提供经济激励。以缅因州为实验室，我们不仅评估 SUD 治疗 PBC，还关注意外的影响和结果；测试一种付款设计，通过将季度支票直接发送给计划达到目标的临床医生/员工来奖励临床医生/一线员工的计划绩效；并深入研究项目和临床医生对激励措施的反应，以了解治疗项目和临床医生如何因这些激励措施而调整组织、管理和临床实践。拟议的研究是与缅因州药物滥用办公室合作进行的，将使用行政数据以及从项目访谈和临床医生/工作人员调查中收集的数据，并结合多层次模型和双重差分法。 PBC 是支付设计的重大变化，可能会影响 SUD 治疗服务的提供方式。随着 PBC 和其他形式的 P4P 的流行率不断增加，了解项目如何响应 PBC 举措至关重要。这种专注于激励响应“黑匣子”的能力是本研究的一个独特且创新的方面。目标 1 和 2 使用 2007 年开始实施的缅因州 PBC 的回顾性数据。对于目标 3 和 4，我们采用了一种新方法来在项目层面分配激励措施，并通过随机设计对其进行检验。具体来说，我们的目标是： 1. 确定 PBC 是否改进了访问和保留的奖励措施，并确定 PBC 带来了哪些积极或消极的意外影响（如果有）。 2. 检查 PBC 如何影响客户结果，控制逆向选择（如果已识别），并确定相关的组织因素。 3. 在项目层面的随机试验中测试是否添加 临床医生团体奖励直接支付给临床医生和一线工作人员，以奖励 PBC 定义的整体项目绩效，从而提高项目绩效。 4. 确定在引入激励措施后通过计划（例如，质量改进举措）或临床医生（例如，对客户的外展）实施哪些改变（如果有）。