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Drug Alcohol Depend. 2018 Feb 1;183:192-200. doi: 10.1016/j.drugalcdep.2017.11.009. Epub 2017 Dec 16.

Agency-level financial incentives and electronic reminders to improve continuity of care after discharge from residential treatment and detoxification.

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Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States; Department of Community Health, Tufts University, United States. Electronic address:
Institute for Behavioral Health, The Heller School for Social Policy and Management, Brandeis University, United States.
The Division of Behavioral Health and Recovery, Washington State Behavioral Health Administration, United States.
Thurston Mason Behavioral Health Organization, United States.



Despite the importance of continuity of care after detoxification and residential treatment, many clients do not receive further treatment services after discharged. This study examined whether offering financial incentives and providing client-specific electronic reminders to treatment agencies lead to improved continuity of care after detoxification or residential treatment.


Residential (N = 33) and detoxification agencies (N = 12) receiving public funding in Washington State were randomized into receiving one, both, or none (control group) of the interventions. Agencies assigned to incentives arms could earn financial rewards based on their continuity of care rates relative to a benchmark or based on improvement. Agencies assigned to electronic reminders arms received weekly information on recently discharged clients who had not yet received follow-up treatment. Difference-in-difference regressions controlling for client and agency characteristics tested the effectiveness of these interventions on continuity of care.


During the intervention period, 24,347 clients received detoxification services and 20,685 received residential treatment. Overall, neither financial incentives nor electronic reminders had an effect on the likelihood of continuity of care. The interventions did have an effect among residential treatment agencies which had higher continuity of care rates at baseline.


Implementation of agency-level financial incentives and electronic reminders did not result in improvements in continuity of care, except among higher performing agencies. Alternative strategies at the facility and systems levels should be explored to identify ways to increase continuity of care rates in specialty settings, especially for low performing agencies.


Continuity of care; Electronic reminders; Financial incentives; Performance measures; Substance use disorder treatment

[Available on 2019-02-01]
[Indexed for MEDLINE]

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