Garner Bryan R, Godley Susan H, Dennis Michael L, Hunter Brooke D, Bair Christin M L, Godley Mark D
Lighthouse Institute, Chestnut Health Systems, Normal, IL 61761, USA.
Arch Pediatr Adolesc Med. 2012 Oct;166(10):938-44. doi: 10.1001/archpediatrics.2012.802.
To test whether pay for performance (P4P) is an effective method to improve adolescent substance use disorder treatment implementation and efficacy.
Cluster randomized trial.
Community-based treatment organizations.
Twenty-nine community-based treatment organizations, 105 therapists, and 986 adolescent patients (953 with complete data).
Community-based treatment organizations were assigned to 1 of the following conditions: the implementation-as-usual (IAU) control condition or the P4P experimental condition. In addition to delivering the same evidence-based treatment (ie, using the Adolescent Community Reinforcement Approach [A-CRA]), each organization received standardized levels of funding, training, and coaching from the treatment developers. Therapists in the P4P condition received US $50 for each month that they demonstrated competence in treatment delivery (ie, A-CRA competence) and US $200 for each patient who received a specified number of treatment procedures and sessions (ie, target A-CRA) that has been found to be associated with significantly improved patient outcomes.
Outcomes included ACRA competence (ie, a therapist-level implementation measure), target A-CRA (ie, a patient-level implementation measure), and remission status (ie, a patient-level treatment effectiveness measure).
Relative to therapists in the IAU control condition, therapists in the P4P condition were significantly more likely to demonstrate A-CRA competence (24.0% vs 8.9%; event rate ratio, 2.24; 95% CI, 1.12- 4.48; P=.02). Relative to patients in the IAU control condition, patients in the P4P condition were significantly more likely to receive target A-CRA (17.3% vs 2.5%; odds ratio, 5.19; 95% CI, 1.53-17.62; P=.01). However, no significant differences were found between conditions with regard to patients' end-of-treatment remission status.
Pay for performance can be an effective method of improving treatment implementation.
clinicaltrials.gov Identifier: NCT01016704
测试绩效薪酬（P4P）是否是提高青少年物质使用障碍治疗实施情况及疗效的有效方法。
整群随机试验。
社区治疗组织。
29个社区治疗组织、105名治疗师和986名青少年患者（953名有完整数据）。
社区治疗组织被分配到以下条件之一：常规实施（IAU）对照条件或P4P实验条件。除了提供相同的循证治疗（即采用青少年社区强化法[A-CRA]）外，每个组织都从治疗开发者那里获得标准化水平的资金、培训和指导。P4P条件下的治疗师如果每月证明其在治疗实施方面具备能力（即A-CRA能力），则可获得50美元，对于接受了特定数量治疗程序和疗程（即目标A-CRA）的每位患者可获得200美元，已发现这些与患者结局显著改善相关。
结局包括ACRA能力（即治疗师层面的实施指标）、目标A-CRA（即患者层面的实施指标）和缓解状态（即患者层面的治疗效果指标）。
与IAU对照条件下的治疗师相比，P4P条件下的治疗师更有可能证明具备A-CRA能力（24.0%对8.9%；事件发生率比，2.24；95%CI，1.12 - 4.48；P = 0.02）。与IAU对照条件下的患者相比，P4P条件下的患者更有可能接受目标A-CRA（17.3%对2.5%；优势比，5.19；95%CI，1.53 - 17.62；P = 0.01）。然而，在患者治疗结束时的缓解状态方面，两组之间未发现显著差异。
绩效薪酬可以是改善治疗实施的有效方法。
clinicaltrials.gov标识符：NCT01016704
