Testing use of payers to facilitate evidence-based practice adoption: protocol for a cluster-randomized trial

Todd Molfenter, Jee-Seon Kim, Andrew Quanbeck, Terry Patel-Porter, Sandy Starr, Dennis McCarty, Todd Molfenter, Jee-Seon Kim, Andrew Quanbeck, Terry Patel-Porter, Sandy Starr, Dennis McCarty

Abstract

Background: More effective methods are needed to implement evidence-based findings into practice. The Advancing Recovery Framework offers a multi-level approach to evidence-based practice implementation by aligning purchasing and regulatory policies at the payer level with organizational change strategies at the organizational level.

Methods: The Advancing Recovery Buprenorphine Implementation Study is a cluster-randomized controlled trial designed to increase use of the evidence-based practice buprenorphine medication to treat opiate addiction. Ohio Alcohol, Drug Addiction, and Mental Health Services Boards (ADAMHS), who are payers, and their addiction treatment organizations were recruited for a trial to assess the effects of payer and treatment organization changes (using the Advancing Recovery Framework) versus treatment organization changes alone on the use of buprenorphine. A matched-pair randomization, based on county characteristics, was applied, resulting in seven county ADAMHS boards and twenty-five treatment organizations in each arm. Opioid dependent patients are nested within cluster (treatment organization), and treatment organization clusters are nested within ADAMHS county board. The primary outcome is the percentage of individuals with an opioid dependence diagnosis who use buprenorphine during the 24-month intervention period and the 12-month sustainability period. The trial is currently in the baseline data collection stage.

Discussion: Although addiction treatment providers are under increasing pressure to implement evidence-based practices that have been proven to improve patient outcomes, adoption of these practices lags, compared to other areas of healthcare. Reasons frequently cited for the slow adoption of EBPs in addiction treatment include, regulatory issues, staff, or client resistance and lack of resources. Yet the way addiction treatment is funded, the payer's role-has not received a lot of attention in research on EBP adoption.This research is unique because it investigates the role of payers in evidence-based practice implementation using a randomized controlled design instead of case examples. The testing of the Advancing Recovery Framework is designed to broaden the understanding of the impact payers have on evidence-based practice (EBP) adoption.

Trial registration: http://NCT01702142 (ClinicalTrials.gov registry, USA).

Figures

Figure 1
Figure 1
The NIATx organizational change model.
Figure 2
Figure 2
Consort Diagram (Enrollment & Intervention Phases).

References

    1. Baker TB, McFall RM, Shoham V. Current status and future prospects of clinical psychology: toward a scientifically principled approach to mental and behavioral health care. Psychol Sci Public Interest. 2008;9(2):67–103.
    1. Bodenheimer T. The American health care system–the movement for improved quality in health care. N Engl J Med. 1999;340(6):488–492. doi: 10.1056/NEJM199902113400621.
    1. Institute of Medicine. Bridging the gap between practice and research: forging partnerships with community based drug and alcohol treatment. Washington, DC: National Academy Press; 1998.
    1. Willinbring ML, Kivlahan D, Kenny M, Grillo M, Hagedorn H, Postier A. Beliefs about evidence-based practices in addiction treatment: a survey of veterans administration program leaders. J Subst Abuse Treat. 2004;26(2):79–85. doi: 10.1016/S0740-5472(03)00161-2.
    1. Garner B. Research on the diffusion of evidence-based treatments within substance abuse treatment: a systematic review. J Subst Abuse Treat. 2009;36(4):376–399. doi: 10.1016/j.jsat.2008.08.004.
    1. Moore TJ, Cohen MR, Furberg CD. Serious adverse drug events reported to the food and drug administration, 1998–2005. Arch Intern Med. 2007;167(16):1752. doi: 10.1001/archinte.167.16.1752.
    1. O’Brien CP. Recent developments in the pharmacotherapy of substance abuse. J Consult Clin Psychol. 1996;64(4):677–686.
    1. Harris AH, Gospodarevskaya E, Ritter AJ. A randomised trial of the cost effectiveness of buprenorphine as an alternative to methadone maintenance treatment for heroin dependence in a primary care setting. PharmacoEconomics. 2005;23(1):77–91. doi: 10.2165/00019053-200523010-00007.
    1. Knudsen HK, Abraham AJ, Roman PM. Adoption and implementation of medications in addiction treatment programs. J Addict Med. 2011;5:21–27. doi: 10.1097/ADM.0b013e3181d41ddb.
    1. Knudsen HK, Roman PM. Financial factors and the implementation of medications for treating opioid use disorders. J Addict Med. 2012;6(4):280–286. doi: 10.1097/ADM.0b013e318262a97a.
    1. Wallack S, Thomas C, Martin T, Chilingerian J, Reif S. Substance abuse treatment organizations as mediators of social policy: slowing the adoption of a congressionally approved medication. J Behav Health Serv Res. 2010;37(1):64–78. doi: 10.1007/s11414-008-9132-4.
    1. Stein BD, Gordon AJ, Sorbero M, Dick AW, Schuster J, Farmer C. The impact of buprenorphine on treatment of opioid dependence in a Medicaid population: recent service utilization trends in the use of buprenorphine and methadone. Drug Alcohol Depend. 2012;123(1–3):72–78.
    1. Ferlie EW, Shortell SH. Improving the quality of health care in the United Kingdom and the United States: a framework for change. Milbank Q. 2001;79(2):281–315. doi: 10.1111/1468-0009.00206.
    1. Grol R. Improving the quality of medical care: building bridges among professional pride, payer profit, and patient satisfaction. JAMA. 2001;286(20):2578–2585. doi: 10.1001/jama.286.20.2578.
    1. Slavin RE. Research on achievement outcomes of success for all. Phi Delta Kappan. 2000;82(1):38.
    1. Rogers EM. Diffusion of innovations. New York: Free Press; 2003.
    1. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629. doi: 10.1111/j.0887-378X.2004.00325.x.
    1. Schmidt LA, Rieckmann T, Abraham A, Molfenter T, Capoccia V, Roman P, Gustafson DH, McCarty D. Advancing Recovery: implementing evidence-based treatment for substance use disorders at the systems level. J Stud Alcohol Drugs. 2012;73(3):413–422.
    1. Simpson DD. A conceptual framework for transferring research to practice. J Subst Abuse Treat. 2002;22(4):171–182. doi: 10.1016/S0740-5472(02)00231-3.
    1. Proctor EK. Leverage points for the implementation of evidence-based practice. Brief Treat Crisis Interv. 2004;4(3):227–242. doi: 10.1093/brief-treatment/mhh020.
    1. Mark TL, Levit KR, Coffey RM, McKusick DR, Harwood HJ, King EC, Bouchery E, Genuardi JS, Vandivort-Warren R, Buck JA, Ryan K. National expenditures for mental health services and substance abuse treatment: 1993-2003.Vol SAMHSA Publication No. SMA 07-4227. Rockville, MD: Substance Abuse and Mental Health ServicesAdministration; 2007.
    1. Quanbeck AR, Gustafson DH, Ford JH II, Pulvermacher A, French MT, McConnell KJ, McCarty D. Disseminating quality improvement: study protocol for a large cluster randomized trial. Implement Sci. 2011;6(1):44. doi: 10.1186/1748-5908-6-44.
    1. Gustafson DH, Quanbeck AR, Robinson JM, Ford JH, II, Pulvermacher A, French MT, McConnell KJ, Batalden PB, Hoffman KA, McCarty D. Which elements of improvement collaboratives are most effective? a cluster-randomized trial. Addiction. in press.
    1. Hsieh FY, Lavori PW, Cohen HJ, Feussner JR. An overview of variance inflation factors for sample-size calculation. Eval Health Prof. 2003;26(3):239–257. doi: 10.1177/0163278703255230.
    1. Raudenbush SW, Spybrook J, Congdon R, Liu X, Martinez A, Bloom H, Hill C. Optimal design software for multi-level and longitudinal research (Version 3.0) [ ]
    1. Knudsen HK, Ducharme LJ, Roman PM. Early adoption of buprenorphine in substance abuse treatment centers: data from the private and public sectors. J Subst Abuse Treat. 2006;30(4):363–373. doi: 10.1016/j.jsat.2006.03.013.
    1. Spybrook J, Raudenbush SW, Liu X, Congdon R, Martinez A. Building capacity to evaluate group-level interventions. .
    1. Raudenbush SW, Liu X. Statistical power and optimal design for multisite randomized trials. Psychol Methods. 2000;5(2):199–213.
    1. Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011;38(1):4–23. doi: 10.1007/s10488-010-0327-7.
    1. McGovern MP, Saunders EC, Kim E. Substance abuse treatment implementation research. J Subst Abuse Treat. 2013;44(1):1–3. doi: 10.1016/j.jsat.2012.09.006.
    1. Gilbert CM, O’Donnell E. The hospital library’s role in recruitment and retention of medical staff. J Hosp Librariansh. 2004;4(4):7–30. doi: 10.1300/J186v04n04_02.
    1. Chamberlain P, Brown CH, Saldana L, Reid J, Wang W, Marsenich L, Sosna T, Padgett C, Bouwman G. Engaging and recruiting counties in an experiment on implementing evidence-based practice in California. Adm Policy Ment Health. 2008;35(4):250–260. doi: 10.1007/s10488-008-0167-x.
    1. Magnabosco JL. Innovations in mental health services implementation: a report on state-level data from the National Evidence-Based Practices Project. Implement Sci. 2006;1:13. doi: 10.1186/1748-5908-1-13.
    1. Bruns EJ, Hoagwood KE, Rivard JC, Wotring J, Marsenich L, Carter B. State implementation of evidence-based practice for youths, Part II: recommendations for research and policy. J Am Acad Child Adolesc Psychiatry. 2008;47:499–504. doi: 10.1097/CHI.0b013e3181684557.
    1. Shea MA, Callis BP, Cassidy-Stewart H, Cranston K, Tomoyasu N. Diffusion of effective HIV prevention interventions--lessons from Maryland and Massachusetts. AIDS Educ Prev. 2006;18:96–107. doi: 10.1521/aeap.2006.18.supp.96.
    1. Raghavan R, Bright CL, Shadoin A. Toward a policy ecology of implementation of evidence-based practices in public mental health settings. Implement Sci. 2008;3(1):26. doi: 10.1186/1748-5908-3-26.
    1. Ganju V. Implementation of evidence-based practices in state mental health systems. Schizophr Bull. 2003;29:125–131. doi: 10.1093/oxfordjournals.schbul.a006982.
    1. Rapp CA, Bond GR, Becker DR, Carpinello SE, Nikkel RE, Gintoli G. The role of state mental health authorities in promoting improved client outcomes through evidence-based practice. Community Ment Health J. 2005;41:347–363. doi: 10.1007/s10597-005-5008-8.
    1. Isett KR, Burnam MA, Coleman-Beattie B, Hyde PS, Morrissey JP, Magnabosco JL, Rapp C, Ganju V, Goldman HH. The role of state mental health authorities in managing change for the implementation of evidence-based practices. Community Ment Health J. 2008;44:195–211. doi: 10.1007/s10597-007-9107-6.

Source: PubMed

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