Use of Performance Based Contracts in Outpatient Substance Abuse Treatment

描述(由申请人提供)：最近NIDA卫生服务研究计划公告(PA)呼吁研究支付机制如何“影响药物滥用或酒精滥用预防和治疗服务的获得程度、提供、利用和质量”。巴勒斯坦权力机构特别呼吁对本研究中提出的绩效承包模式进行评估。尽管医学研究所提出了建议，但关于绩效合同对普通医疗或行为卫生保健质量的影响的文献很少。2001年在特拉华州实施了第一批以业绩为基础的治疗药物滥用(SA)合同之一。这个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，为当前和未来在SA治疗和其他领域使用基于绩效的合同提供信息。本研究将使用行政数据和设施调查来分析：1)通过分析这些契约绩效指标的变化，控制客户特征，分析PBC项目是否达到了提高设施占有率、客户主动参与治疗和完成治疗的目标。2)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的变化的影响，并控制客户的严重程度。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置设计。虽然将使用定量方法检验所有假设，但将进行设施调查，以提供更多必要的背景和细节，以了解建设和平委员会的影响和设施对建设和平委员会的反应。通过调查获得的信息将使对建设和平委员会的描述更加完整。将使用多级建模技术进行所有回归分析，以说明设施内客户的聚集性。这些技术是分析集群数据的一种日益流行的方法。随着基于绩效的合同继续发展，拟议的研究将为政策制定者和SA治疗提供者提供宝贵的信息。这项研究将通过探索药物滥用治疗质量改进倡议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.