Garner Bryan R, Tueller Stephen J, Bradshaw Michael, Speck Kathryn J, Satre Derek, Rash Carla, Donohoe Tom, Mungo Jackie, Philbrick Sarah, Ruwala Richa, Roosa Mathew R, Zehner Mark, Ford James H
The Ohio State University College of Medicine and Public Health: The Ohio State University College of Medicine.
RTI International.
Res Sq. 2024 Aug 9:rs.3.rs-4614222. doi: 10.21203/rs.3.rs-4614222/v1.
Substance use disorders (SUDs) have a serious adverse impact on the physical and mental well-being of people with HIV. Previously, using a 39-site dual-randomized type 2 hybrid trial design, findings from the Substance Abuse Treatment to HIV Care Project supported the Implementation and Sustainment Facilitation (ISF) strategy to improve implementation and effectiveness of a motivational interviewing brief intervention (MIBI) for SUD within HIV service settings across the United States (US). Building on this trial, this parallel cluster-randomized type 3 hybrid trial aimed to test the incremental effectiveness of a pay-for-performance (P4P), a form of the "alter incentive/allowance structures" strategy.
Twenty-six HIV service organizations, their staff participants (N=87), and their client participants (N=341) were cluster-randomized to one of two implementation conditions. The control condition included staff-focused training, feedback, and consultation (TFC) and team-focused implementation and sustainment (ISF). The experimental condition included TFC+ISF as well as P4P (TFC+ISF+P4P). P4P used financial incentives to reward MIBI implementation (US$10 per MIBI delivered) and MIBI implementation at or above a pre-defined level of quality (US$10 per demonstration). In addition to these outcomes, past 4-week changes/reductions in client participant's days of primary substance use and anxiety symptoms were examined.
The addition of P4P had a large and significant effect on the number of MIBIs implemented (=1.30, p<.05) and reduction in anxiety (=-1.54), but there was no impact on days of substance use. P4P had large effects on MIBI quality (=1.24) and MIBI implementation effectiveness (=1.28), but these were not significant (<.10).
P4P is a form of the "alter incentive/allowance structures" strategy. Its function is to reward the implementation of a clinical innovation. Rewarding implementation is consistent with the theory of implementation effectiveness, which suggests implementation climate (i.e., the extent to which implementation is expected, supported, and rewarded) is a key antecedent of implementation effectiveness (i.e., the consistency and quality of implementation). We found that P4P had a significant, positive impact on MIBI implementation in HIV service settings, but client-level outcomes were mixed. Future research should examine the effectiveness of the P4P strategy to improve implementation and sustainment of other evidence-based innovations.
ClinicalTrials.gov: NCT04687917. Registered 12/18/2020.
物质使用障碍（SUDs）对艾滋病毒感染者的身心健康有严重不利影响。此前，物质滥用治疗与艾滋病毒护理项目采用39个地点的双随机2型混合试验设计，其研究结果支持实施与维持促进（ISF）策略，以提高美国艾滋病毒服务机构中针对SUD的动机性访谈简短干预（MIBI）的实施情况和有效性。在此试验基础上，这项平行整群随机3型混合试验旨在测试绩效薪酬（P4P）（一种“改变激励/津贴结构”策略的形式）的增量有效性。
26个艾滋病毒服务机构、其工作人员参与者（N = 87）及其客户参与者（N = 341）被整群随机分配到两种实施条件之一。对照条件包括以工作人员为重点的培训、反馈和咨询（TFC）以及以团队为重点的实施与维持（ISF）。实验条件包括TFC + ISF以及P4P（TFC + ISF + P4P）。P4P使用经济激励措施来奖励MIBI的实施（每次实施MIBI奖励10美元）以及达到或高于预先定义质量水平的MIBI实施（每次示范奖励10美元）。除了这些结果外，还考察了客户参与者过去4周内主要物质使用天数和焦虑症状的变化/减少情况。
增加P4P对实施的MIBI数量有很大且显著的影响（β = 1.30，p <.05），并能减轻焦虑（β = -1.54），但对物质使用天数没有影响。P4P对MIBI质量（β = 1.24）和MIBI实施效果（β = 1.28）有很大影响，但这些影响不显著（p <.10）。
P4P是“改变激励/津贴结构”策略的一种形式。其作用是奖励临床创新的实施。奖励实施与实施有效性理论一致，该理论表明实施氛围（即实施被期望、支持和奖励的程度）是实施有效性（即实施的一致性和质量）的关键前提。我们发现P4P对艾滋病毒服务机构中MIBI的实施有显著的积极影响，但客户层面的结果好坏参半。未来的研究应考察P4P策略在改善其他循证创新的实施和维持方面的有效性。
ClinicalTrials.gov：NCT04687917。于2020年12月18日注册。
