Evidence map›Paper›PMID 31790980›Full record

ReviewDrug and alcohol dependence2020

Is it feasible to pay specialty substance use disorder treatment programs based on patient outcomes?

Dominic Hodgkin, Deborah W Garnick, Constance M Horgan, Alisa B Busch, Maureen T Stewart, Sharon Reif

Open access · greenAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Drug and alcohol dependence, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
2.7field-weighted citation impact, top 7% of its field
1 · What the graph read from 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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 8 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Payment and Financing for Substance Use Screening and Brief Intervention for Adolescents and Adults in Health, School, and Community Settings.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2022
    Review
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 2 institutions in 1 country.

Dominic HodgkinInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, USA. Electronic address: hodgkin@brandeis.edu.
Deborah W GarnickInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, USA.
Constance M HorganInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, USA.
Alisa B BuschMcLean Hospital, and the Department of Health Care Policy, Harvard Medical School, USA.
Maureen T StewartInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, USA.
Sharon ReifInstitute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, USA.
Brandeis University · USHarvard University · US

Funding

Research Support CoreP30DA035772 · NIDA · BRANDEIS UNIVERSITY · PI Haiden A Huskamp, SHARON REIF · 2015 to 2026
$11.3M
Incentives in Public Addiction Treatment: Testing Design and Enhancing ImpactR01DA033402 · NIDA · BRANDEIS UNIVERSITY · PI REIF, SHARON · 2012 to 2016
$2.2M
Incentives and Alerts for Improving Performance in Washington StateR01DA033468 · NIDA · BRANDEIS UNIVERSITY · PI GARNICK, DEBORAH W. · 2012 to 2016
$2.0M
NIDA NIH HHS P30 DA035772NIDA NIH HHS R01 DA033402NIDA NIH HHS R01 DA033468
6 · The paper itself

Abstract

backgroundSome US payers are starting to vary payment to providers depending on patient outcomes, but this approach is rarely used in substance use disorder (SUD) treatment. PURPOSE: We examine the feasibility of applying a pay-for-outcomes approach to SUD treatment.

methodsWe reviewed several relevant literatures: (1) economic theory papers that describe the conditions under which pay-for-outcomes is feasible in principle; (2) description of the key outcomes expected from SUD treatment, and the measures of these outcomes that are available in administrative data systems; and (3) reports on actual experiences of paying SUD treatment providers based on patient outcomes.

resultsThe economics literature notes that when patient outcomes are strongly influenced by factors beyond provider control and when risk adjustment performs poorly, pay-for-outcomes will increase provider financial risk. This is relevant to SUD treatment. The literature on SUD outcome measurement shows disagreement on whether to include broader outcomes beyond abstinence from substance use. Good measures are available for some of these broader constructs, but the need for risk adjustment still brings many challenges. Results from two past payment experiments in SUD treatment reinforce some of the concerns raised in the more conceptual literature.

conclusionThere are special challenges in applying pay-for-outcomes to SUD treatment, not all of which could be overcome by developing better measures. For SUD treatment it may be necessary to define outcomes more broadly than for general medical care, and to continue conditioning a sizeable portion of payment on process measures.

Indexed as

Patient Outcome AssessmentFeasibility StudiesHumansInsurance, Health, ReimbursementSubstance Abuse Treatment CentersSubstance-Related DisordersTreatment OutcomeOutcomes measurementPay-for-outcomesPay-for-performanceProvider paymentRisk adjustment

Identifiers

PMID31790980
PMCPMC6941579
OpenAlexW2989054918

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.