Open Access Open Badges Study protocol

Testing use of payers to facilitate evidence-based practice adoption: protocol for a cluster-randomized trial

Todd Molfenter1*, Jee-Seon Kim1, Andrew Quanbeck1, Terry Patel-Porter2, Sandy Starr3 and Dennis McCarty4

Author Affiliations

1 Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Avenue, Madison, Wisconsin 53706, USA

2 Ohio Dept. of Alcohol & Drug Addiction Services, 30 W. Spring Street, 6th Floor, Columbus, Ohio 43215-2256, USA

3 Outcomes, and Research, Ohio Dept. of Alcohol & Drug Addiction Services, 30 W. Spring Street, 6th Floor, Columbus, Ohio 43215-2256, USA

4 Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, Oregon 97239-3098, USA

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Implementation Science 2013, 8:50  doi:10.1186/1748-5908-8-50

Published: 10 May 2013



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.


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.


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.

Trial registration

http://NCT01702142 webcite ( registry, USA)

Evidence-based practice implementation; Buprenorphine; Addiction treatment; Innovation