August 29, 2012
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Pay for performance may improve treatment for adolescent substance use disorders

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Offering financial incentives to therapists appeared to be an effective method of improving the implementation of an adolescent substance use treatment program, according to study results published in the Archives of Pediatrics and Adolescent Medicine. However, no significant differences were observed in remission rates between pay-for-performance and implementation-as-usual care.

Bryan R. Garner, PhD, and colleagues of the Lighthouse Institute in Illinois, conducted a randomized trial involving 29 community-based treatment organizations that were assigned either to a control group, which operated as-usual, or a group that initiated pay for performance (P4P). Each organization delivered the same substance use treatment program, named the Adolescent Community Reinforcement Approach (A-CRA), designed to help adolescents replace substance use behaviors by rewarding positive behaviors.

Therapists in the P4P group could earn $200 for each of their patients who received at least 10 of 12 procedures specific to the A-CRA program within the first 14 weeks of treatment and in no fewer than seven sessions — a goal the researchers refer to as “target A-CRA.” Therapists in the P4P group were also paid $50 for each month they demonstrated competence in treatment delivery.

Adjusted analysis showed that P4P therapists were significantly more likely to demonstrate competence compared with therapists in the control group (24% vs. 8.9%; event rate ratio=2.24; 95% CI, 1.12-4.48). Patients in the P4P condition were significantly more likely to receive target A-CRA vs. patients assigned to the control group (17.3% vs. 2.5%; OR=5.19; 95% CI, 1.53-17.62). The researchers observed no significant differences in patient remission status between the two groups (41.8% for P4P vs. 50.8% for control group; OR=0.68; 95% CI, 0.35-1.33).

Because the large effects of P4P on treatment implementation did not have a significant effect on remission status, Garner and colleagues conducted post-hoc analyses to determine the association between A-CRA competence and target A-CRA with remission. They found that therapist A-CRA competence was not significantly associated with remission status (P=.82), but target A-CRA was (OR=1.91; 95% CI, 1.02-3.58).

“Findings from this trial suggest that P4P can be an effective method of improving implementation of evidence-based treatment in practice settings,” the researchers wrote.

Disclosure: The researchers report no relevant financial disclosures.