Agency-level financial incentives and electronic reminders to improve continuity of care after discharge from residential treatment and detoxification

Acevedo, Andrea; Lee, Margaret T.; Garnick, Deborah W.; Horgan, Constance M.; Ritter, Grant; Panas, Lee; Campbell, Kevin; Bean-Mortinson, Jason

doi:10.1016/j.drugalcdep.2017.11.009

Cited by 15 publications

(10 citation statements)

References 38 publications

(50 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study provides newer national-level estimates for inpatient drug detoxification, and our results suggest a similarly low level of rehabilitation service use during inpatient detoxification. The low utilization of additional DUD treatment during inpatient detoxification may be related to a high hospital treatment cost and/or a lack of an infrastructure or organizational support to promote DUD treatment [ 10 , 42 , 43 ]. Since the 1980s, some health plans (e.g., managed care) have sought to reduce the cost of DUD treatment by shifting inpatient care toward outpatient care [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

National trends and characteristics of inpatient detoxification for drug use disorders in the United States

Zhu

2018

BMC Public Health

View full text Add to dashboard Cite

BackgroundPrior studies indicate that the opportunity from detoxification to engage in subsequent drug use disorder (DUD) treatment may be missed. This study examined national trends and characteristics of inpatient detoxification for DUDs and explored factors associated with receiving DUD treatment (i.e., inpatient drug detoxification plus rehabilitation) and discharges against medical advice (DAMA).MethodsWe analyzed inpatient hospitalization data involving the drug detoxification procedure for patients aged≥12 years (n = 271,403) in the 2003–2011 Nationwide Inpatient Samples. We compared the estimated rate and characteristics of inpatient drug-detoxification hospitalizations between 2003 and 2011 and determined demographic and clinical correlates of inpatient drug detoxification plus rehabilitation (versus detoxification-only) and DAMA (versus transfer to further treatment).ResultsThere was no significant yearly change in the population rate of inpatient drug-detoxification hospitalizations during 2003–2011. The majority of inpatient drug detoxification were patients aged 35–64 years, males, and those on Medicaid. Among inpatient drug-detoxification hospitalizations, only 13% received detoxification plus rehabilitation during inpatient care, and up to 14% were DAMA; the most commonly identified diagnoses were opioid use disorder (OUD; 75%) and non-addiction mental health disorders (48%). Being on Medicaid (vs. having private insurance) and having OUD (vs. no OUD) were associated with decreased odds of receiving detoxification plus rehabilitation, as well as increased odds of DAMA.ConclusionsThese findings suggest the presence of a potentially large detoxification-treatment gap for inpatient detoxification patients. They highlight the need for implementing DUD services to improve engagement in receiving further DUD treatment in order to improve recovery and health outcomes.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5982-8) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

National trends and characteristics of inpatient detoxification for drug use disorders in the United States

Zhu

2018

BMC Public Health

View full text Add to dashboard Cite

show abstract

“…Building on previous work in designing incentives, agencies in the incentives arms could earn points based on quarterly performance rates based on achievement (performance above a minimum achievement threshold) or improvement (raising their continuity rate above their own baseline). Electronic reminders were in the form of an Excel workbook, sent weekly through secure email by Washington State's Behavioral Health Administration (BHA) to treatment agency staff, with information to “alert” them to clients who may be at risk of not meeting the continuity criteria …”

Section: Methodsmentioning

confidence: 99%

“…The 33 residential agencies were randomized into 4 arms (with 8 or 9 agencies per arm): incentives, alerts, both, and control. Due to their smaller number, detoxification agencies were randomized to 3 arms (with 4 agencies per arm): incentives, alerts, and control . Our current study is based on clients from participating agencies whose ZIP Code of residence was classified as rural based on Rural Urban Commuting Area (RUCA) codes to determine whether clients live in urban/rural areas, including as rural the categories of large rural town, small rural town, and isolated.…”

Section: Methodsmentioning

confidence: 99%

“…This original evaluation, which did not take travel time into consideration, found that financial incentives did not have an effect on the likelihood of continuity after detoxification or residential treatment. However, follow‐up analyses determined there was a positive effect on timely continuity among residential treatment agencies, which had higher continuity rates at baseline, and electronic reminders either alone or in conjunction with financial incentives had significant positive effects only among clients at residential treatment facilities which had moderate continuity rates at baseline . In considering how travel time may affect these results, we anticipate that travel time may exert a negative impact on continuity of care, but that financial interventions might moderate this impact.…”

Section: Geographic Accessmentioning

confidence: 97%

“…However, follow-up analyses determined there was a positive effect on timely continuity among residential treatment agencies, which had higher continuity rates at baseline, and electronic reminders either alone or in conjunction with financial incentives had significant positive effects only among clients at residential treatment facilities which had moderate continuity rates at baseline. 30 In considering how travel time may affect these results, we anticipate that travel time may exert a negative impact on continuity of care, but that financial interventions might moderate this impact. That is, agencies could use the additional funds and information to facilitate linkage to ongoing treatment for clients whose detoxification or residential treatment was farther from their home.…”

Section: Financial Incentives and Electronic Remindersmentioning

confidence: 99%

See 2 more Smart Citations

Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts

Garnick

Horgan

Acevedo

et al. 2019

The Journal of Rural Health

Self Cite

View full text Add to dashboard Cite

Purpose Treatment after discharge from detoxification or residential treatment is associated with improved outcomes. We examined the influence of travel time on continuity into follow‐up treatment and whether financial incentives and weekly alerts have a modifying effect. Methods For a research intervention during October 2013 to December 2015, detoxification and residential substance use disorder treatment programs in Washington State were randomized into 4 groups: potential financial incentives for meeting performance goals, weekly alerts to providers, both interventions, and control. Travel time was used as both a main effect and interacted with other variables to explore its modifying impact on continuity of care in conjunction with incentives or alerts. Continuity was defined as follow‐up care occurring within 14 days of discharge from detoxification or residential treatment programs. Travel time was estimated as driving time from clients’ home ZIP Code to treatment agency ZIP Code. Findings Travel times to the original treatment agency were in some cases significant with longer travel times predicting lower likelihood of continuity. For detoxification clients, those with longer travel times (over 91 minutes from their residence) are more likely to have timely continuity. Conversely, residential clients with travel times of more than 1 hour are less likely to have timely continuity. Interventions such as alerts or incentives for performance had some mitigating effects on these results. Travel times to the closest agency for potential further treatment were not significant. Conclusions Among rural clients discharged from detoxification and residential treatment, travel time can be an important factor in predicting timely continuity.

show abstract

The effects of on-screen, point of care computer reminders on processes and outcomes of care

Shojania

Jennings²,

Mayhew

et al. 2009

Cochrane Database of Systematic Reviews

360

339

View full text Add to dashboard Cite

Background The opportunity to improve care by delivering decision support to clinicians at the point of care represents one of the main incentives for implementing sophisticated clinical information systems. Previous reviews of computer reminder and decision support systems have reported mixed effects, possibly because they did not distinguish point of care computer reminders from e-mail alerts, computer-generated paper reminders, and other modes of delivering ‘computer reminders’. Objectives To evaluate the effects on processes and outcomes of care attributable to on-screen computer reminders delivered to clinicians at the point of care. Search methods We searched the Cochrane EPOC Group Trials register, MEDLINE, EMBASE and CINAHL and CENTRAL to July 2008, and scanned bibliographies from key articles. Selection criteria Studies of a reminder delivered via a computer system routinely used by clinicians, with a randomised or quasi-randomised design and reporting at least one outcome involving a clinical endpoint or adherence to a recommended process of care. Data collection and analysis Two authors independently screened studies for eligibility and abstracted data. For each study, we calculated the median improvement in adherence to target processes of care and also identified the outcome with the largest such improvement. We then calculated the median absolute improvement in process adherence across all studies using both the median outcome from each study and the best outcome. Main results Twenty-eight studies (reporting a total of thirty-two comparisons) were included. Computer reminders achieved a median improvement in process adherence of 4.2% (interquartile range (IQR): 0.8% to 18.8%) across all reported process outcomes, 3.3% (IQR: 0.5% to 10.6%) for medication ordering, 3.8% (IQR: 0.5% to 6.6%) for vaccinations, and 3.8% (IQR: 0.4% to 16.3%) for test ordering. In a sensitivity analysis using the best outcome from each study, the median improvement was 5.6% (IQR: 2.0% to 19.2%) across all process measures and 6.2% (IQR: 3.0% to 28.0%) across measures of medication ordering. In the eight comparisons that reported dichotomous clinical endpoints, intervention patients experienced a median absolute improvement of 2.5% (IQR: 1.3% to 4.2%). Blood pressure was the most commonly reported clinical endpoint, with intervention patients experiencing a median reduction in their systolic blood pressure of 1.0 mmHg (IQR: 2.3 mmHg reduction to 2.0 mmHg increase). Authors’ conclusions Point of care computer reminders generally achieve small to modest improvements in provider behaviour. A minority of interventions showed larger effects, but no specific reminder or contextual features were significantly associated with effect magnitude. Further research must identify design features and contextual factors consistently associated with larger improvements in provider behaviour if computer reminders are to succeed on more than a trial and error basis.

show abstract

Agency-level financial incentives and electronic reminders to improve continuity of care after discharge from residential treatment and detoxification

Cited by 15 publications

References 38 publications

National trends and characteristics of inpatient detoxification for drug use disorders in the United States

National trends and characteristics of inpatient detoxification for drug use disorders in the United States

Rural Clients’ Continuity Into Follow‐Up Substance Use Disorder Treatment: Impacts of Travel Time, Incentives, and Alerts

The effects of on-screen, point of care computer reminders on processes and outcomes of care

Contact Info

Product

Resources

About