Incentivized Collaborative Care to Desseminate Contingency Management

摘要 应急管理是一种基于激励的干预措施，拥有庞大的研究基础， 在增加阿片类药物使用者的药物戒断和药物依从性方面显示出疗效 disorder.在支持这一方法的证据与其在欧洲的传播之间存在巨大差距。 实践一个克服了大多数传播障碍的数字健康计划已经开发出来 收集所有相关数据并实施所有应急管理程序 的自动该计划已被证明是有效的，在几个同行评审的研究。不过有一 传播的主要障碍仍然存在。为了使应急管理真正对一个 在全国范围内，医疗服务提供者必须积极地让患者参与进来，告知他们有关信息，鼓励他们使用， 帮助他们登记，然后使用平台生成的数据来告知他们正在进行的护理。的 克服这最后一个障碍的最好方法是使用应急管理本身的激励技术; 激励供应商的必要行为。因此，SBIR快速通道应用程序建议开发和 评估一种新的激励协作护理模式，用于提供应急管理服务 用于阿片类药物使用障碍的丁丙诺啡药物治疗患者。我们相信这一模式将具有 增加丁丙诺啡药物治疗的可及性的重要次要影响，因为处方者将 间接激励最大限度地增加丁丙诺啡患者的数量。第一阶段将开始 准备活动，包括简化登记制度，使任何丁丙诺啡 开处方者可以使用它，增加提供者信息的数据收集系统，以及 提供者可以使用它来轻松访问他们希望查看的患者数据。第一阶段可行性研究（n = 10）将 跟随.这些里程碑需要激励合作护理模式在传播方面的潜力 应急管理要做好示范。如果成功，可行性研究将为 随机对照试验（RCT）。该随机对照试验将是SBIR奖励第二阶段的主要活动， 旨在评估激励协作护理在传播应急 管理主要结果指标将包括参与与以下方面有关的合作护理： 应急管理干预，以及丁丙诺啡处方趋势。次要分析将 旨在评估DynamiCare对提供者的经济影响。RCT还将包括探索性 分析患者的结果。总的来说，该项目与国家药物管制和预防犯罪局目前的优先事项高度一致， “确定和解决与应急管理干预措施有关的政策障碍（激励措施 激励措施）”和“探索激励措施和数字成瘾治疗的报销”。如果 如果该项目取得成功，将导致迅速传播应急管理， 丁丙诺啡药物治疗阿片类药物使用障碍的人在整个美国。

ABSTRACT Contingency management, an incentive-based intervention, boasts a massive research base and has been demonstrated efficacy in increasing drug abstinence and medication adherence in people with opioid use disorder. There is a huge gap between the evidence in support of this approach and its dissemination in practice. A digital health program that surmounts most of the barriers to dissemination has been developed that collects all the relevant data and implements all of the contingency management procedures automatically. This program has been shown to be efficacious in several peer-reviewed studies. However, one key barrier to dissemination remains. In order for contingency management to become truly impactful on a national scale, providers must actively engage patients by informing them about it, encouraging them to use it, assisting their enrollment, and then using the data generated by the platform to inform their ongoing care. The best way to surmount this final barrier is to use the motivational technique of contingency management itself; incentivize the necessary provider behaviors. Thus, this SBIR Fast Track application proposes to develop and evaluate a novel incentivized collaborative care model for the delivery of contingency management services for buprenorphine pharmacotherapy patients with opioid use disorders. We believe this model will have the important secondary effect of increasing access to buprenorphine pharmacotherapy, as prescribers will be indirectly incentivized to maximize the number of buprenorphine patients in their practice. Phase I will begin with preparatory activities, including streamlining the enrollment system so that any buprenorphine prescriber can use it, adding data collection systems for provider information, and data display systems that providers can use to easily access the patient data they wish to see. A Phase I feasibility study (n = 10) will follow. The milestones require the potential of the incentivized collaborative care model in disseminating contingency management to be demonstrated. If successful, the feasibility study will pave the way for a randomized controlled trial (RCT). This RCT will be the primary activity of Phase II of this SBIR award, and is designed to evaluate the efficacy of incentivized collaborative care in the dissemination of contingency management. Primary outcome measures will include the engagement in collaborative care in relation to the contingency management intervention, as well as buprenorphine prescribing trends. Secondary analyses will be designed to assess the economic effect of DynamiCare on providers. The RCT will also include exploratory analyses of patient outcomes. Overall, this project is highly consistent with current ONDCP priorities to, “Identify and address policy barriers related to contingency management interventions (motivational incentives),” and “Explore reimbursement for motivational incentives and digital treatment for addiction.” If successful, this project could lead to rapid dissemination of contingency management and improved access to buprenorphine pharmacotherapy to people with opioid use disorder throughout the United States.