Use of Performance Based Contracts in Outpatient Substance Abuse Treatment

描述（由申请人提供）：最近的NIDA卫生服务研究计划公告（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得，交付，利用和质量”的方式。巴勒斯坦权力机构特别要求对本研究报告中提出的业绩合同模式进行评价。尽管医学研究所的建议，很少出版存在的影响，绩效合同的质量一般医疗或行为健康护理。2001年，特拉华州实施了第一批基于绩效的药物滥用（SA）治疗合同。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，这将告知当前和未来的使用基于绩效的合同在SA治疗和其他领域。本研究将使用行政数据和设施调查：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计划是否达到了改善设施占用率、客户积极参与治疗和完成治疗的目标。2)分析设施特征的影响，例如来自公共客户的收入比例、组织规模和激励目标，对客户满足积极参与标准的概率随时间的变化的影响，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后设计。虽然将使用定量方法检验所有假设，但将进行一次设施调查，以提供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所需的更多背景和细节。通过调查获得的信息将有助于更全面地描述建设和平委员会。所有回归分析将使用多级建模技术进行，以说明设施内客户的聚类。这些技术是分析聚类数据的一种越来越流行的方法。随着基于绩效的合同的不断发展，拟议的研究将为政策制定者和SA治疗提供者提供有价值的信息。这项研究将通过探索药物滥用治疗质量改进举措的影响来改善公共卫生。

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.