Use of Performance Based Contracts in Outpatient Substance Abuse Treatment

描述（由申请人提供）：最近的一份NIDA卫生服务研究方案公告（PA）呼吁研究支付机制“影响药物滥用或酒精滥用预防和治疗服务的获取、提供、利用和质量的程度”的方式。正如本研究中提出的那样，PA特别要求对绩效合同模式进行评估。尽管医学研究所（Institute of Medicine）提出了建议，但关于绩效合同对一般医疗或行为卫生保健质量的影响的文章却很少。2001年在特拉华州实施了首批药物滥用治疗基于绩效的合同之一。该项目的目标是提高我们对PBC如何工作以及它如何影响SA治疗质量的理解。这项研究的结果将提供有价值的信息，为目前和未来在SA治疗和其他领域使用基于绩效的合同提供信息。本研究将使用管理数据和设施调查：1)通过分析这些合同绩效指标随时间的变化，控制客户特征，分析PBC计划是否达到了提高设施占用率，客户积极参与治疗和完成治疗的目标。2)在控制客户严重程度的情况下，分析公共客户收入比例、组织规模和激励目标等设施特征对客户满足积极参与标准的概率随时间变化的影响。3)确定SA治疗组织是否以及如何应对从基于成本的合同到基于绩效的支付系统的变化。本研究采用准实验前后设计。虽然所有假设都将使用定量方法进行测试，但将进行设施调查，以提供额外的背景和必要的细节，以了解PBC的影响以及设施对PBC的反应。通过调查获得的信息将允许对PBC进行更完整的描述。所有回归分析将使用多层建模技术进行，以解释设施内客户的聚类。这些技术是分析聚类数据的一种日益流行的方法。随着绩效合同的不断发展，拟议的研究将为决策者和SA治疗提供者提供有价值的信息。这项研究将通过探索提高药物滥用治疗质量举措的影响来改善公众健康。

DESCRIPTION (provided by applicant): A recent NIDA Health Services Research Program Announcement (PA) called for studies of the ways in which payment mechanisms "affect the degree of access to, and delivery, utilization, and quality of prevention and treatment services for drug abuse or alcohol abuse". The PA specifically called for evaluations of performance contracting models, as proposed in this study. Despite recommendations from the Institute of Medicine, little published exists on the impact of performance contracting on quality of general medical or behavioral health care. One of the first performance based contracts (PBC) for substance abuse (SA) treatment was implemented in Delaware in 2001. The goals of this project are to improve our understanding of how PBC works and how it impacts quality of SA treatment. Results of this study will provide valuable information which will inform current and future use of performance based contracting in SA treatment and in other areas. This study will use administrative data and a facility survey to: 1) Analyze whether the PBC program met its' goals of improving facility occupancy, client active participation in treatment and completion of treatment by analyzing the change in these contracted performance measures overtime, controlling for client characteristics. 2) Analyze the impact of facility characteristics such as the proportion of revenue from public clients, size of the organization and target of incentives, on the change in the probability of clients meeting the active participation criteria over time, controlling for client severity. 3) Determine whether and how SA treatment organizations responded to the change from a cost based contract to a performance based payment system. This study employs a quasi- experimental pre-post design. While all hypotheses will be tested using quantitative methods, a facility survey will be conducted to provide additional context and detail necessary to understand the impact of the PBC and facilities' responses to the PBC. Information obtained through the survey will allow for a more complete description of the PBC. All regression analyses will be conducted using multilevel modeling techniques to account for clustering of clients within facilities. These techniques are an increasingly popular method for analysis of clustered data. The proposed research will provide valuable information for policy makers and SA treatment providers as performance based contracts continue to develop. This study will improve public health by exploring the impact of quality improvement initiatives for substance abuse treatment.