Incentivized Collaborative Care to Desseminate Contingency Management

摘要 应急管理是一种以激励为基础的干预措施，拥有巨大的研究基础，并一直 阿片类药物使用者在提高药物戒断率和服药依从性方面的有效性 无序。支持这一方法的证据与其在 练习一下。一项跨越大多数传播障碍的数字健康计划已经开发完成 收集所有相关数据并实施所有应急管理程序 自动的。这一计划在几项同行评议的研究中被证明是有效的。然而，有一个 传播的关键障碍仍然存在。为了使应急管理真正对 在全国范围内，提供者必须通过告知患者、鼓励他们使用它来积极地吸引患者， 帮助他们注册，然后使用平台生成的数据来通知他们正在进行的护理。这个 跨越这最后一道障碍的最好方法是使用应急管理本身的激励技术； 激励必要的提供者行为。因此，该SBIR Fast Track应用程序建议开发和 评估用于提供应急管理服务的新型激励式协作护理模式 丁丙诺啡类药物治疗阿片类药物使用障碍患者。我们相信这款车型将会有 增加丁丙诺啡药物治疗的重要副作用，因为处方者将 间接激励最大限度地增加丁丙诺啡患者的执业数量。第一阶段将开始 开展筹备活动，包括简化登记制度，使任何丁丙诺啡 处方者可以使用它，添加用于提供者信息的数据收集系统，以及 提供者可以使用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 跟着。这些里程碑需要激励性协作护理模式在传播 应急管理有待示范。如果成功，可行性研究将为 随机对照试验(RCT)。该RCT将是该SBIR奖项第二阶段的主要活动，并且 旨在评估激励性协作护理在传播应急措施方面的有效性 管理层。主要结果指标将包括参与与以下方面有关的协作护理 应急管理干预，以及丁丙诺啡处方趋势。二次分析将 旨在评估DynamiCare对提供商的经济影响。RCT还将包括探索性 病人结局分析。总体而言，该项目与ONDCP当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(激励性 激励)，“和”和“探索报销的动机激励和数字治疗成瘾。”如果 如果成功，该项目可能导致应急管理的迅速传播，并改善获得 丁丙诺啡为全美阿片类药物使用障碍患者提供药物治疗。

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.