PROVIDER AND CLIENT ADHERENCE IN ALCOHOL ABUSE TREATMENT

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APPLICANT'S ABSTRACT: Public treatment programs for treatment of substance abuse are increasingly being held accountable for their outcome and cost performance. In some cases, funding is partially conditioned on the attainment of cost or performance targets, employing similar tactics to those used by private managed care organizations. In an earlier NIDA-funded project, we studied how Maine's Performance-Based Contracting (PBC) system affected public agency performance as reported to the state funding authority, and the effectiveness of substance abuse treatment at the client level. In this R21 application, we request two years of funding to pursue questions raised in that earlier research related to the veracity of reports in the state data system, and to the determinants of client continuation and completion of treatment. We use already collected data from 1994-1998, including a new data set collected in 1996, but not yet analyzed, to pursue the following specific aims: 1. Compare the reporting practices of clinicians in the state data system and in the field data collected by the investigators based on clinical records. A number of performance measures, such as frequency of use before admission and at discharge, abstinence, progress during treatment, and reduction in use will be defined and compared. We will test for any systematic bias in reporting, a behavior we label "gaming." 2.Analyze the determinants of gaming as defined in Aim 1. A set of hypotheses will be developed to distinguish between gaming as an altruistic response to perceived client need and a financial incentive response by clinicians. Use the field data set to study the visit-by-visit decisions by clients and providers to continue treatment. Test the effects of financial incentives, including PBC, on provider and client behavior related to retention in treatment.