Facilitation and incentivization improved speed of contingency management adoption, exposure, and submission

Contingency management (CM) is a highly effective adjunct to medication for opioid use disorder that is rarely offered in specialty addiction treatment programs. Primary outcome analysis of the Project MIMIC (Maximizing Implementation of Motivational Incentives in Clinics) type 3 hybrid effectiveness-implementation trial found that adding facilitation and incentivization to the implementation strategy delivered by the Addiction Technology Transfer Centers (ATTCs)) improved CM consistency (CM Adoption, CM Exposure) and quality (CM Submission, CM Competence). In the current secondary analysis, we tested the hypothesis that programs receiving the Enhanced ATTC (E-ATTC) strategy would have faster speed of attaining these benchmarks relative to those receiving the ATTC strategy. We cluster randomized 28 opioid treatment programs and 186 providers to receive either the ATTC or E-ATTC strategy. The ATTC strategy contained three components based on the robust literature on provider training: didactic workshop, performance feedback, and consultation. The E-ATTC strategy contained two additional elements targeting implementation climate: team-based facilitation and provider-level incentivization. Over a 9-month Implementation phase, providers in both conditions logged CM sessions weekly in an online CM Tracker from which data were extracted on CM Adoption and CM Exposure. Providers submitted audio-recorded CM sessions monthly that were coded by raters blind to condition to assess CM Submission and CM Competence. Providers randomized to E-ATTC had higher rates of attaining all four outcomes: CM Adoption, CM Exposure, CM Submission, CM Competence. In Cox regression analyses controlling for covariates, providers receiving E-ATTC had faster speed of attaining three of the four outcomes (CM Adoption, CM Exposure, CM Submission). At any given timepoint, rates of attainment in the E-ATTC condition were 119% to 142% higher for these three outcomes. Additionally, attainment of CM Adoption and CM Exposure occurred 68 to 121 days faster in the E-ATTC condition. Targeting implementation climate via facilitation and incentivization can potentially improve the speed of achieving CM consistency and quality benchmarks relative to the standard strategies used by intermediary purveyor organizations. This study adds to a growing body of literature suggesting that intentionally selected implementation strategies can accelerate the implementation process. This study was registered in Clinicaltrials.gov (NCT03931174) on April 23, 2019.