Trial reportImplementation science : IS2018
Pay-for-performance as a cost-effective implementation strategy: results from a cluster randomized trial.
Trial report in Implementation science : IS, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01016704 (Reinforcing Therapist Performance), which is not on this map. Cited by 19 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Reinforcing Therapist Performance
Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Association of Alternative Payment and Delivery Models With Outcomes for Mental Health and Substance Use Disorders: A Systematic Review.JAMA network open · 2020Pooled it
- Budget Impact Analysis of the Balanced Opioid Initiative: A Cluster Randomized Trial Aimed at Deprescribing Opioids for Chronic Pain in Primary Care Settings.Annals of family medicine · 2026Trial
- Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics): results of a 28-site cluster-randomized type 3 hybrid trial.Implementation science : IS · 2025Trial
- Addressing unmet need for substance use disorder treatment among youth in the legal system (YLS): Costs of structured implementation interventions with juvenile justice agencies in seven states.Journal of substance use and addiction treatment · 2025Trial
- Design and implementation of a Type-2 hybrid, prospective randomized trial of opioid agonist therapies integration into primary care clinics in Ukraine.Contemporary clinical trials · 2024Trial
- Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics): A cluster-randomized type 3 hybrid effectiveness-implementation trial.Addiction science & clinical practice · 2021Trial
- Financial Incentives to Increase Cardiac Rehabilitation Participation Among Low-Socioeconomic Status Patients: A Randomized Clinical Trial.JACC. Heart failure · 2019Trial
- From global guidelines for cardio-kidney-metabolic diseases management to national implementation: perspectives from the guideline workshop taskforce.Cardiovascular diabetology · 2026Article
- Barriers and Facilitators to Implementing a School-Based Social and Emotional Learning Program for Rural Children in China: A Qualitative Study Using the Consolidated Framework for Implementation Research.Administration and policy in mental health · 2025Article
- The STop UNhealthy substance use now (STUN II) trial: protocol for a 48-site cluster randomized 2 × 2 factorial implementation trial to improve evidence-based screening and interventions for substance use disorder within primary care.Implementation science : IS · 2025Article
- Enduring contributions to implementation science: Honoring the legacy of Bryan R. Garner.Frontiers in health services · 2025Article
- Article
- Virtual Training Is More Cost-Effective Than In-Person Training for Preparing Staff to Implement Contingency Management.Journal of technology in behavioral science · 2022Article
- Scoping review of costs of implementation strategies in community, public health and healthcare settings.BMJ open · 2022Article
- From innovative applications of the effectiveness-implementation hybrid trial design to the dissemination, implementation, effectiveness, sustainment, economics, and level-of-scaling hybrid trial design.Frontiers in health services · 2022Article
- Priority domains, aims, and testable hypotheses for implementation research: Protocol for a scoping review and evidence map.Systematic reviews · 2020Article
- The implementation & sustainment facilitation (ISF) strategy: Cost and cost-effectiveness results from a 39-site cluster randomized trial integrating substance use services in community-based HIV service organizations.Implementation research and practiceArticle
- A scoping review of strategies for financing the implementation of evidence-based practices in behavioral health systems: State of the literature and future directions.Implementation research and practiceArticle
- Using Incentivization as a Strategy to Improve Implementation of a Motivational Interviewing Brief Intervention for Substance Use Disorders in HIV Settings: Results of a 26-Site Parallel Groups Cluster-Randomized Type-3 Hybrid Trial.Implementation research and practiceArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
backgroundPay-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).
methodsBuilding 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.
resultsAt 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).
conclusionThis study provides experimental evidence supporting P4P as a cost-effective implementation strategy.
trial registrationNCT01016704 .
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.