TY - JOUR
KW - buprenorphine
KW - Emergency Service, Hospital
KW - Humans
KW - Motivation
KW - Opioid-Related Disorders/drug therapy
KW - policy
KW - United States
KW - Emergency department
KW - Financial incentives
KW - implementation science
KW - opioid use disorder
KW - Pay for performance
AU - A. S. Kilaru
AU - S. F. Lubitz
AU - J. Davis
AU - W. Eriksen
AU - S. Siegel
AU - D. Kelley
AU - J. Perrone
AU - Z. F. Meisel
A1 - 
AB - OBJECTIVE: In 2019, Pennsylvania established a voluntary financial incentive program designed to increase the engagement in addiction treatment for Medicaid patients with opioid use disorder after emergency department (ED) encounters. In this qualitative study involving hospital leaders, the authors examined decisions leading to participation in this program as well as barriers and facilitators that influenced its implementation. METHODS: Twenty semistructured interviews were conducted with leaders from a diverse sample of hospitals and health systems across Pennsylvania. Interviews were planned and analyzed following the Consolidated Framework for Implementation Research. An iterative approach was used to analyze the interviews and determine key themes and patterns regarding implementation of this policy initiative in hospitals. RESULTS: The authors identified six key themes that reflected barriers and facilitators to hospital participation in the program. Participation in the program was facilitated by community partners capable of arranging outpatient treatment for opioid use disorder, incentive payments focusing hospital leadership on opioid treatment pathways, multidisciplinary planning, and flexibility in adapting pathways for local needs. Barriers to program participation concerned the implementation of buprenorphine prescribing and the measurement of treatment outcomes. CONCLUSIONS: A financial incentive policy encouraged hospitals to enact rapid system and practice changes to support treatment for opioid use disorder, although challenges remained in implementing evidence-based treatment-specifically, initiation of buprenorphine-for patients visiting the ED. Analysis of treatment outcomes is needed to further evaluate this policy initiative, but new delivery and payment models may improve systems to treat patients who have an opioid use disorder.
AD - National Clinician Scholars Program, University of Pennsylvania, and Corporal Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia (Kilaru); Center for Emergency Care Policy and Research, Department of Emergency Medicine (Kilaru, Lubitz, Perrone, Meisel), and Mixed Methods Research Lab, Department of Family Medicine and Community Health (Davis, Eriksen), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia (Perrone, Meisel); Hospital and Healthsystem Association of Pennsylvania, Harrisburg (Siegel); Office of Medical Assistance Programs, Pennsylvania Department of Human Services, Harrisburg (Kelley).; National Clinician Scholars Program, University of Pennsylvania, and Corporal Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia (Kilaru); Center for Emergency Care Policy and Research, Department of Emergency Medicine (Kilaru, Lubitz, Perrone, Meisel), and Mixed Methods Research Lab, Department of Family Medicine and Community Health (Davis, Eriksen), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia (Perrone, Meisel); Hospital and Healthsystem Association of Pennsylvania, Harrisburg (Siegel); Office of Medical Assistance Programs, Pennsylvania Department of Human Services, Harrisburg (Kelley).; National Clinician Scholars Program, University of Pennsylvania, and Corporal Michael J. Crescenz Veterans Affairs (VA) Medical Center, Philadelphia (Kilaru); Center for Emergency Care Policy and Research, Department of Emergency Medicine (Kilaru, Lubitz, Perrone, Meisel), and Mixed Methods Research Lab, Department of Family Medicine and Community Health (Davis, Eriksen), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Center for Addiction Medicine and Policy, University of Pennsylvania, Philadelphia (Per(TRUNCATED)
BT - Psychiatric services (Washington, D.C.)
C5 - Education & Workforce; Financing & Sustainability; Healthcare Disparities; Opioids & Substance Use
CP - 9
CY - United States
DO - 10.1176/appi.ps.202000501
IS - 9
JF - Psychiatric services (Washington, D.C.)
LA - eng
M1 - Journal Article
N2 - OBJECTIVE: In 2019, Pennsylvania established a voluntary financial incentive program designed to increase the engagement in addiction treatment for Medicaid patients with opioid use disorder after emergency department (ED) encounters. In this qualitative study involving hospital leaders, the authors examined decisions leading to participation in this program as well as barriers and facilitators that influenced its implementation. METHODS: Twenty semistructured interviews were conducted with leaders from a diverse sample of hospitals and health systems across Pennsylvania. Interviews were planned and analyzed following the Consolidated Framework for Implementation Research. An iterative approach was used to analyze the interviews and determine key themes and patterns regarding implementation of this policy initiative in hospitals. RESULTS: The authors identified six key themes that reflected barriers and facilitators to hospital participation in the program. Participation in the program was facilitated by community partners capable of arranging outpatient treatment for opioid use disorder, incentive payments focusing hospital leadership on opioid treatment pathways, multidisciplinary planning, and flexibility in adapting pathways for local needs. Barriers to program participation concerned the implementation of buprenorphine prescribing and the measurement of treatment outcomes. CONCLUSIONS: A financial incentive policy encouraged hospitals to enact rapid system and practice changes to support treatment for opioid use disorder, although challenges remained in implementing evidence-based treatment-specifically, initiation of buprenorphine-for patients visiting the ED. Analysis of treatment outcomes is needed to further evaluate this policy initiative, but new delivery and payment models may improve systems to treat patients who have an opioid use disorder.
PP - United States
PY - 2021
SN - 1557-9700; 1075-2730
SP - 1048
EP - 1056
EP - 
T1 - A State Financial Incentive Policy to Improve Emergency Department Treatment for Opioid Use Disorder: A Qualitative Study
T2 - Psychiatric services (Washington, D.C.)
TI - A State Financial Incentive Policy to Improve Emergency Department Treatment for Opioid Use Disorder: A Qualitative Study
U1 - Education & Workforce; Financing & Sustainability; Healthcare Disparities; Opioids & Substance Use
U2 - 33593105
U3 - 10.1176/appi.ps.202000501
VL - 72
VO - 1557-9700; 1075-2730
Y1 - 2021
Y2 - Sep 1
ER -