title: Pay-for-performance in a community substance abuse clinic.
abstract: Pay-for-performance (P4P) strategies improve employee productivity and morale in business settings and are increasingly being implemented in medical care settings. This study investigated whether P4P could improve treatment utilization and retention at a community drug treatment clinic. Counselors had the opportunity to earn cash bonuses based on therapy attendance rates of individual clients and on the quarterly retention rates of their caseload. Using a pre-post study design, average therapy sessions attended during the first month of treatment increased from 4.6 sessions prior to the intervention to 5.5 sessions per client during the intervention. The 90-day client retention rate increased from 40% to 53%. Additional analyses suggest that the improvement in the 90-day retention was mediated by the increase in attendance during the first month of treatment. This project demonstrates that implementing a P4P incentive program in community drug abuse treatment clinics is feasible and effective at improving utilization and retention.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA. rvandrey@jhmi.edu
authors.forename: Ryan
authors.initials: R
authors.lastname: Vandrey
authors.forename: Maxine L
authors.initials: ML
authors.lastname: Stitzer
authors.forename: Shauna P
authors.initials: SP
authors.lastname: Acquavita
authors.forename: Patricia
authors.initials: P
authors.lastname: Quinn-Stabile
mesh_terms: D000328:Adult; D003376:Counseling; D004649:Employee Incentive Plans; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012456:Salaries and Fringe Benefits / Q000639:trends*; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000534:rehabilitation* / Q000628:therapy; D013997:Time Factors