Abstract:
BACKGROUND:Pay-for-performance (P4P) has been recommended as a promising strategy to improve implementation of high-quality care. This study examined the incremental cost-effectiveness of a P4P strategy found to be highly effective in improving the implementation and effectiveness of the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based treatment (EBT) for adolescent substance use disorders (SUDs). METHODS:Building on a $30 million national initiative to implement A-CRA in SUD treatment settings, urn randomization was used to assign 29 organizations and their 105 therapists and 1173 patients to one of two conditions (implementation-as-usual (IAU) control condition or IAU+P4P experimental condition). It was not possible to blind organizations, therapists, or all research staff to condition assignment. All treatment organizations and their therapists received a multifaceted implementation strategy. In addition to those IAU strategies, therapists in the IAU+P4P condition received US $50 for each month that they demonstrated competence in treatment delivery (A-CRA competence) and US $200 for each patient who received a specified number of treatment procedures and sessions found to be associated with significantly improved patient outcomes (target A-CRA). Incremental cost-effectiveness ratios (ICERs), which represent the difference between the two conditions in average cost per treatment organization divided by the corresponding average difference in effectiveness per organization, and quality-adjusted life years (QALYs) were the primary outcomes. RESULTS:At trial completion, 15 organizations were randomized to the IAU condition and 14 organizations were randomized to the IAU+P4P condition. Data from all 29 organizations were analyzed. Cluster-level analyses suggested the P4P strategy led to significantly higher average total costs compared to the IAU control condition, yet this average increase of 5% resulted in a 116% increase in the average number of months therapists demonstrated competence in treatment delivery (ICER = $333), a 325% increase in the average number of patients who received the targeted dosage of treatment (ICER = $453), and a 325% increase in the number of days of abstinence per patient in treatment (ICER = $8.134). Further supporting P4P as a cost-effective implementation strategy, the cost per QALY was only $8681 (95% confidence interval $1191-$16,171). CONCLUSION:This study provides experimental evidence supporting P4P as a cost-effective implementation strategy. TRIAL REGISTRATION:NCT01016704 .
journal_name
Implement Scijournal_title
Implementation science : ISauthors
Garner BR,Lwin AK,Strickler GK,Hunter BD,Shepard DSdoi
10.1186/s13012-018-0774-1subject
Has Abstractpub_date
2018-07-04 00:00:00pages
92issue
1issn
1748-5908pii
10.1186/s13012-018-0774-1journal_volume
13pub_type
杂志文章,随机对照试验abstract:BACKGROUND:This paper describes the intervention planning process for the Home and Online Management and Evaluation of Blood Pressure (HOME BP), a digital intervention to promote hypertension self-management. It illustrates how a Person-Based Approach can be integrated with theory- and evidence-based approaches. The Pe...
journal_title:Implementation science : IS
pub_type: 杂志文章,评审
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abstract:BACKGROUND:Case management has emerged as a promising alternative approach to supplement traditional one-on-one sessions between patients and doctors for improving the quality of care in chronic diseases such as coronary heart disease (CHD). However, data are lacking in terms of its efficacy and cost-effectiveness when...
journal_title:Implementation science : IS
pub_type: 杂志文章
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abstract:BACKGROUND:Patients with opioid use disorder (OUD) frequently present to the emergency department (ED) after overdose, or seeking treatment for general medical conditions, their addiction, withdrawal symptoms, or complications of injection drug use, such as soft tissue infections. ED-initiated buprenorphine has been sh...
journal_title:Implementation science : IS
pub_type: 杂志文章
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abstract:BACKGROUND:Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy-makers. Using a psychosocial theoretical framework, this study aimed at exploring the factors affecting physician intention to adopt HTA recommendations. T...
journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-1-8
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abstract:BACKGROUND:The need to better understand processes of removing, reducing, or replacing healthcare services that are no longer deemed essential or effective is common across publicly funded healthcare systems. This paper explores expert international opinion regarding, first, the factors and processes that shape the suc...
journal_title:Implementation science : IS
pub_type: 杂志文章
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abstract:BACKGROUND:Osteoarthritis is a leading cause of pain and disability worldwide. Despite research supporting best practice, evidence-based guidelines are often not followed. Little is known about the implementation of non-surgical models of care in routine primary care practice. From a knowledge mobilisation perspective,...
journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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abstract:BACKGROUND:There is a need to unpack the empirical, practical, and personal challenges within participatory approaches advocated to optimize implementation. The unpredictable, chaotic nature of participatory approaches complicates application of implementation theories, methods, and strategies which do not address rese...
journal_title:Implementation science : IS
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abstract:BACKGROUND:This study examined the effectiveness of seven different interventions designed to increase the proportion of general practitioners (GPs) accepting an offer of free access to an online evidence-based resource. METHODS:Australian GPs (n = 14,000) were randomly selected and assigned to seven intervention grou...
journal_title:Implementation science : IS
pub_type: 杂志文章
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journal_title:Implementation science : IS
pub_type: 杂志文章
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更新日期:2008-04-22 00:00:00
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journal_title:Implementation science : IS
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更新日期:2010-11-29 00:00:00
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journal_title:Implementation science : IS
pub_type: 社论
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abstract:BACKGROUND:The Centers for Disease Control (2018) estimates that 1 in 59 children has autism spectrum disorder, and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on general...
journal_title:Implementation science : IS
pub_type: 杂志文章
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更新日期:2018-05-09 00:00:00
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journal_title:Implementation science : IS
pub_type: 杂志文章
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更新日期:2008-06-02 00:00:00
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journal_title:Implementation science : IS
pub_type: 杂志文章
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journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/1748-5908-3-56
更新日期:2008-12-17 00:00:00
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journal_title:Implementation science : IS
pub_type: 杂志文章
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更新日期:2019-12-17 00:00:00
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journal_title:Implementation science : IS
pub_type: 杂志文章
doi:10.1186/s13012-019-0860-z
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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更新日期:2010-10-22 00:00:00
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
pub_type: 杂志文章,随机对照试验
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更新日期:2018-09-04 00:00:00
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journal_title:Implementation science : IS
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journal_title:Implementation science : IS
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