title: Testing use of payers to facilitate evidence-based practice adoption: protocol for a cluster-randomized trial.
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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  http://NCT01702142 (ClinicalTrials.gov registry, USA).
authors.affiliation: Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin 53706, USA. todd.molfenter@chess.wisc.edu
authors.forename: Todd
authors.initials: T
authors.lastname: Molfenter
authors.forename: Jee-Seon
authors.initials: JS
authors.lastname: Kim
authors.forename: Andrew
authors.initials: A
authors.lastname: Quanbeck
authors.forename: Terry
authors.initials: T
authors.lastname: Patel-Porter
authors.forename: Sandy
authors.initials: S
authors.lastname: Starr
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
mesh_terms: D002047:Buprenorphine / Q000191:economics / Q000627:therapeutic use*; D002985:Clinical Protocols; D016000:Cluster Analysis; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006801:Humans; D009292:Narcotic Antagonists / Q000191:economics / Q000627:therapeutic use*; D009726:Nurses / Q000600:supply & distribution; D009820:Ohio; D058850:Opiate Substitution Treatment / Q000191:economics; D009293:Opioid-Related Disorders / Q000191:economics / Q000534:rehabilitation*; D009936:Organizational Innovation / Q000191:economics; D010820:Physicians / Q000600:supply & distribution; D012051:Reimbursement Mechanisms; D018401:Sample Size
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine