Psychiatry

[Summary in Progress] 

Psychiatry Literature

(288) Bremer RW, Scholle SH, Keyser D, Hourtsinger JVK, Pincus HA. Pay for Performance in Behavioral Health. Psychiatric Services. 2008: 59 1419-1429.

PMID: 19033169

Summary:

  • Effort to identify P4P programs in behavioral health. Chart of the programs is detailed.
  • Overall, there is less consensus on a common set of quality improvement strategies and measures in behavioral health care.
  • 24 specific P4P programs were found for behavioral health issues.
  • Authors discuss preliminary lessons learned from behavioral P4P programs already in place.

Significance to Literature:

P4P in behavioral fields is relatively behind when assessing gross amount of available programs and measures.

 

(494) Stewart, R. E., Lareef, I., Hadley, T. R., & Mandell, D. S. (2017). Can We Pay for Performance in Behavioral Health Care?. Psychiatric services (Washington, D.C.), 68(2), 109–111.

PMID: 2790314

Summary:

  • Limited P4P in behavioral health data suggest that external incentives lead to positive outcomes at the patient, clinical, and organizational level.
  • Due to the complexity of operationalizing mental health patient outcomes such as functioning status, behavioral health P4P research lacks definitive patient clinical outcome measures. Instead, research has focused on “proxies” of good clinical care.
  • Current P4P in mental health care research is not uniform as there is a wide range of outcome measures across diverse locations, specialties within behavioral health, and levels of incentives.
  • P4P in behavioral health has had some unintended consequences, such as patient selection, dumping, and other gaming behaviors. There is a need for more research to be done to mitigate these concerns.

Significance to Literature:

More systematic research on P4P in behavioral health is needed as outcome measures are not uniform, are not definitive patient clinical outcome measures, and research designs have led to unintended consequences of gaming behaviors.

 

(495) Lee, M. T., Garnick, D. W., O'Brien, P. L., Panas, L., Ritter, G. A., Acevedo, A., Garner, B. R., Funk, R. R., & Godley, M. D. (2012). Adolescent treatment initiation and engagement in an evidence-based practice initiative. Journal of substance abuse treatment, 42(4), 346–355.

PMID: 22047793

Summary:

  • A study examining program factors to predict initiation and engagement of adolescents in substance abuse treatment found adolescents treated in a P4P group were more likely to initiate treatment.
  • As patient initiation into substance abuse treatment was not the specific target of P4P implementation, this finding is hypothesized to be the result of P4P’s monetary bonus incentivizing implementation of proven treatment procedures.

Significance to Literature:

Demonstrates need for further research into the benefits of P4P in program factors, such as initiation of treatment, in behavioral health programs.

 

(496) Garner, B. R., Godley, S. H., & Bair, C. M. (2011). The impact of pay-for-performance on therapists' intentions to deliver high-quality treatment. Journal of substance abuse treatment41(1), 97–103.

PMID: 21315539

Summary:

  • This paper examined and used the framework of the theory of planned behavior (TPB) and found that therapists’ attitudes towards the quality care targets were significantly associated with their intentions to achieve high quality care.
  • This paper demonstrates that P4P methods significantly increased therapists’ intentions to achieve quality care targets built on evidence-based treatment.
  • Provides support for using P4P approaches as a method of increasing the quality of behavioral health care.

Significance to Literature:

Provides some of the first evidence that P4P programs positively impact therapists’ intentions to achieve pre-defined quality targets being reinforced which has been found to be a key predictor of actual behavior. As stated above, this provides support for P4P approaches as a method of increasing the quality of behavioral health care.

 

(497) Lu, M., & Ma, C. T. (2006). Financial incentives and gaming in alcohol treatment. Inquiry: a journal of medical care organization, provision and financing, 43(1), 34–53.

PMID: 16838817

Summary:

  • Implementing P4P financial incentives in behavioral health increases gaming behavior.
  • When financial incentives were positively related to treatment outcomes, data supported the hypothesis that clinicians overstated patient severity at the start of treatment, and understated severity at the end.

Significance to Literature:

More systematic research on how to mitigate gaming behavior that presents in P4P behavioral health implementation is needed.