Nudges and Incentives to Enhance the Opioid Treatment Workforce
Phase: NA
Conditions: Opioid Abuse (Disorder)
Sponsor: University of North Carolina, Chapel Hill

Nudges and Incentives to Enhance the Opioid Treatment Workforce 
 
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Complete Title:  Nudges and Incentives to Enhance the Opioid Treatment Workforce 
 
 
 
 
Short Title:  Nudges and Incentives to Enhance the Opioid Treatment Workforce 
Sponsor:  National Institute on Drug Abuse (NIDA) 
Protocol Date:  May 20, 2021 
NCT03834025 
 
 
 
 
 
 
 
Sponsor  
National Institute on Drug Abuse (NIDA) 
Three White Flint North 
11601 Landsdown St 
North Bethesda, MD 20852 
 
Study Principal Investigator:  Marisa E. Domino, PhD 
The University of North Carolina at Chapel Hill 
Cecil G. Sheps Center for HSR 
725 Martin Luther King Jr Blvd 
Chapel Hill, NC 27599-7590 
 
Phone 919-966-3891 
email: domino@unc.edu 
 
 
 
 

Nudges and Incentives to Enhance the Opioid Treatment Workforce 
 
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PROTOCOL TITLE:  
Nudges and Incentives to Enhance the Opioid Treatment Workforce  
Short Title:  
Nudges and Incentives to Enhance the Opioid Treatment Workforce  
Lead Investigator: 
Marisa E. Domino, PhD 
 The University of North Carolina at Chapel Hill 
Protocol Version: 1.0  
Version Date: May 20, 2021 
 
I confirm that I have read this protocol and understand it.    
Principal Investigator Name:  
 
Marisa E. Domino 
 
 
 
 
Principal Investigator Signature:  
  
 
Date:   
 
 
 
5/20/2021 
 
 
 
 
 
 
 
 
 

Nudges and Incentives to Enhance the Opioid Treatment Workforce 
 
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TABLE OF CONTENTS 
Table of Contents ................................................................................................................. 3 
Abbreviations and Definitions of Terms ................................................................................ 4 
Protocol Synopsis ................................................................................................................. 5 
1 
BACKGROUND  AND RATIONALE .......................................................................................................................... 8 
2 
STUDY OBJECTIVES ................................................................................................................................................ 9 
3 
INVESTIGATIONAL PLAN ..................................................................................................................................... 10 
4 
STUDY PROCEDURES ........................................................................................................................................... 12 
5 
STUDY EVALUATIONS AND MEASUREMENTS ................................................................................................... 12 
6 
STATISTICAL CONSIDERATIONS .......................................................................................................................... 12 
7 
STUDY INTERVENTION (DEVICE OR OTHER INTERVENTION) ............................................................................ 13 
8 
STUDY INTERVENTION ADMINISTRATION ......................................................................................................... 13 
9 
SAFETY MANAGEMENT ....................................................................................................................................... 13 
10  DATA COLLECTION AND MANAGEMENT ............................................................................................................ 13 
11 RECRUITMENT STRATEGY ................................................................................................................................... 14 
12 CONSENT PROCESS ............................................................................................................................................. 14 
13 PUBLICATION ....................................................................................................................................................... 15 
14 REFERENCES ........................................................................................................................................................ 16 
Appendix ........................................................................................................................... 20 
 
 
 
 
 
 
 
 
 
 
 
 
 

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ABBREVIATIONS AND DEFINITIONS OF TERMS 
 
 
 
 
Abbreviation 
Definition 
PCP 
Primary care provider 
ECHO 
Extension for Community Healthcare Outcomes is a model of professional development that 
uses video conferencing technology to bring experts into even the most rural areas to support 
primary care providers 
MAT 
Medication-assisted treatment. The term Medications for Opioid Use Disorder (MOUD) has 
generally replaced MAT in its reference to the set of medications, although the role of 
psychosocial therapy is different between the two terms. We will generally use MOUD going 
forward but the term MAT is used herein for historical accuracy. 
 MOUD 
 Medications for Opioid Use Disorder 
 
 
 

Nudges and Incentives to Enhance the Opioid Treatment Workforce 
 
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PROTOCOL SYNOPSIS 
 
Study Title:  Nudges and Incentives to Enhance the Opioid Treatment Workforce  
Funder 
NIDA 
Study Rationale 
Opioid overdoses currently claim the lives of 115 Americans per 
day. This epidemic is alarming, not just in its effects on the lives of 
individuals and families, but also on the light it has shined on the 
disturbing lack of treatment options in many areas. A number of 
effective treatments are available for opioid use disorder, but many 
require special training beyond a professional degree.  In addition, 
the complex comorbidities and life circumstances faced by those 
with an opioid use disorder can deter many providers from 
investing the time needed to learn how to diagnose and treat 
individuals needing these services. To date, of North Carolina’s 
8087 primary care physicians, 4669 nurse practitioners, and 4237 
physician assistants, only 785 (<5%) have undergone the waiver 
training required to provide medication assisted treatment (MAT) 
for opioid use disorder, a miniscule number of North Carolina’s 
primary care workforce. Many waiver-trained providers are not yet 
prescribing, due in part to the lack of on-going education or 
support, so the effective rate of treatment provision is substantially 
lower than 5%. Further, only one-fifth of NC’s zip codes have a 
waiver-trained provider. ECHO is an evidence-supported hub-and-
spoke model of professional development that uses video 
conferencing technology to bring experts into even the most rural 
areas to support primary care providers. ECHO for MAT is program 
in NC that uses the ECHO model to develop a provider workforce 
that is equipped to provide MAT to those in need of treatment, 
preventing further accidental deaths from overdose. The time 
commitment required to develop MAT proficiency can prove to be 
a barrier to take up since provider time participating in ECHO may 
represent lost revenue from not seeing patients. This challenge can 
especially prohibit participation from small and rural practices, 
often where treatment is most needed.  This research project will 
conduct a pilot study to examine the extent to which informational 
nudges incorporating specific information from a provider’s 
community into recruitment materials (Aim 1) and financial 
incentives (Aim 2) affect participation in ECHO MAT by primary care 
providers. Through these estimates, this study will contribute 
much-needed information on the incentives that can be used to 
create a behavioral health workforce that is ready to meet the 
challenges of the opioid epidemic. 

Nudges and Incentives to Enhance the Opioid Treatment Workforce 
 
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Study Objective(s) 
Aim 1: To estimate the influence of informational nudges on the 
engagement of primary care providers in an opioid treatment 
learning collaborative to address the opioid overdose crisis. 
Aim 2: To estimate the influence of financial incentives on the 
participation intensity of primary care providers in an opioid 
treatment learning collaborative to address the opioid overdose 
crisis. 
Study Design 
 
The study is designed to be implemented in two phases. Phase 1 is 
the recruitment phase.  Providers will be randomized to receive 
recruitment letters and emails from 1 of 4 conditions.  
Randomization for this phase will occur at the practice level, as 
determined by provider address.  Participants that contact the 
study team and enroll in the study will begin Phase 2 of the       
study.  
In Phase 2 of the study participants will be randomly assigned to 
rewards for participation in ECHO MAT learning collaborative. Their 
participation in the learning collaborative will be tracked. Phase 2 
of the study is a pilot. 
Subject Population 
key criteria for Inclusion 
and Exclusion: 
Inclusion Criteria 
1. Licensed practicing Primary Care Provider (MD, DO, PA, NP) 
2. Currently practicing in NC, not currently participating in ECHO 
MAT 
Exclusion Criteria 
1. Another member of the same practice is already enrolled in the 
study (one provider per practice in Phase 2) 
2. Active participation in The University of North Carolina at 
Chapel Hill (UNC) ECHO Collaborative at beginning of study 
Number of Subjects 
Up to 80 to achieve at least 20 in each reimbursement arm 
Study Duration 
Each subject’s participation will last six months with the exception 
of participants who had not completed as of 3/9/2020 whose 
participation was extended by 3 months due to decreased learning 
collaborative sessions resulting from COVID-19. 
The entire study is expected to last up to two years  
Study Phases 
Screening 
Study Treatment 
Follow-Up   
(1) Recruitment: recruitment materials (letters or emails) sent 
once randomized to 1 of 4 conditions.  Once participant 
enrolls, then 
(2) Randomization to 1 of 3 study arms:  enrolled participants are 
re-randomized to 1 of 3 levels of reimbursement to estimate 
the influence of financial incentives in participation in learning 
collaboratives to address the opioid overdose crisis.  
Participation in learning collaboratives over 6 months will be 

Nudges and Incentives to Enhance the Opioid Treatment Workforce 
 
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tracked.  Participation in learning collaboratives will be tracked 
over 9 months for participants who did not complete as of 
3/9/2020 due to the COVID-19 pandemic. 
 
Safety Evaluations 
The risk to participants is minimal. 
Statistical and Analytic 
Plan 
In Aim 1, we anticipate starting with a random selection of 600 
providers from the list of eligible NC providers generated from the 
NPI Registry, limiting to primary care providers identified through 
taxonomy codes, which gives more than 90% power to detect a ten 
percentage point difference in the binary outcome, response to 
study recruitment. We will use binary models (logit, linear 
probability models) to examine response to recruitment as a 
function of study arm, controlling for provider type and county 
fixed effects.    
For Aim 2, we will randomly recruit up to 80 providers as needed to 
have at least 20 providers per arm enrollees for this phase of the 
pilot (20 providers per arm).   The outcome to be monitored for 
Aim 2 is the number of ECHO sessions attended in the 6 months 
following randomization. Because this is a pilot study, the sample 
size is not powered for the primary outcome, number of ECHO 
clinics attended.  We will conduct a negative binomial or other 
count data model (depending on statistical tests) of the number of 
sessions as a function of financial incentive arm to estimate the 
effect of financial incentives on participation. 
DATA AND SAFETY 
MONITORING PLAN 
The risk to participants is minimal, and this does not meet the 
definition of a clinical trial, thus there is no data safety monitoring 
plan. 
 
 
 

Nudges and Incentives to Enhance the Opioid Treatment Workforce 
 
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1 
BACKGROUND AND RATIONALE 
 
The major goals of the project are:  
Aim 1: To estimate the influence of informational nudges on the engagement of primary care providers 
in an opioid treatment learning collaborative to address the opioid overdose crisis. Primary care 
providers in North Carolina, including physicians, nurse practitioners, and physician assistants, will be 
randomly assigned to receive either a pro-social recruitment approach for participating in the UNC 
ECHO MAT intervention or standard recruitment practice. Treatment assignment will provide pro-social 
information, including customized figures on the opioid use epidemic in the provider’s region and the 
degree of the provider shortage in their region. The comparison arm will include a standard approach to 
recruitment that does not contain a pro-social recruitment message. Analysis of this data will provide 
estimates of the degree of responsiveness of providers to informational nudges.  
Aim 2: To estimate the influence of financial incentives on the participation intensity of primary care 
providers in an opioid treatment learning collaborative to address the opioid overdose crisis. At the 
second stage, providers agreeing to enroll in the program will be re-randomized to one of three levels of 
reimbursement for time spent participating in the UNC ECHO MAT intervention. Analysis of this data will 
provide causal estimates of the degree of responsiveness of provider participation intensity to financial 
incentives. A sub-aim will examine whether the effect of incentives on participation intensity varies 
between the pro-social recruitment group and status-quo recruitment group. The results from this study 
will inform the feasibility and design of a full-scale trial testing the effects and cost-effectiveness of 
approaches to address the shortage of adequately trained primary care clinicians, providing urgently 
needed information on best practices in developing the health care workforce to treat individuals and 
communities most affected by the opioid crisis.  
1.1 
Introduction 
This project seeks to examine a critical barrier to optimizing the health care workforce for the treatment 
of opioid use disorders. Without a dramatic increase in the number of primary care providers trained 
and comfortable with the many nuances of prescribing medication-assisted treatment (MAT), the 
staggering increases in opioid overdose deaths will continue to skyrocket. However, Drug Addiction 
Treatment Act (DATA) 2000 waiver training alone is not enough to facilitate prescribing for patients who 
desperately need services; an estimated 40% of physicians with waivers do not initiate MAT 
prescriptions. To address this problem, North Carolina developed a learning collaborative framework to 
promote MAT training.  Learning collaboratives have been shown to be an efficacious approach to 
increase utilization of MAT, but engagement among providers in North Carolina has been low. To date, 
the need to encourage provider collaborative participation at scale has not been addressed. This is the       
critical problem focused on in this study.        
The death rate from accidental opioid overdoses continues to climb at an alarming rate, with       
overdose deaths in 2016 almost five times the number from 1999. The daily death rate from opioid 
overdoses in the U.S. alone is now estimated at 115, so every day that evidence-based treatment is not 
available leads to more preventable deaths. North Carolina is one of the states with both an opioid 
overdose death rate greater than the national average (11.9 vs 10.4 deaths per 100,000, age-adjusted) 

Nudges and Incentives to Enhance the Opioid Treatment Workforce 
 
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and a rate of increase in opioid overdose deaths greater than the national average (19% vs. 16%). North 
Carolina is also one of four states with an Agency for Healthcare Research and Quality (AHRQ) funded 
Extension for Community Healthcare Outcomes (ECHO) MAT learning collaborative available to primary 
care practices, but engagement among providers is low. While the main barriers to engagement are 
incompletely understood, recent evidence from provider interviews conducted by the study team in 
December 2017 and January 2018 suggest that one substantial barrier is the time required for weekly       
ECHO clinics. 
1.2 
Name and Description of Investigational Product or Intervention  
Receipt of recruitment letter is the Intervention for Aim 1. 
Randomized to one of three levels of financial reimbursement for their time in the ECHO sessions is the 
intervention for the second level of the study. 
1.3 
Non-Clinical and Clinical Study Findings 
Potential Benefits.  This study seeks to determine the extent to which financial incentives and 
informational nudges increase the participation of providers in a learning collaborative to support the 
expansion of MAT, thereby increasing the percentage of physicians, who get DATA-2000 waiver training 
and certified to provide MAT, who go onto implementation this lifesaving evidence-based practice in 
underserved counties. 
Potential Risks.  The potential risks of the intervention are minimal and patients in the care of these 
medical practices may benefit by having more decision-making involvement in their care and access to 
needed MAT. There is a small risk of breach of confidentiality.  Procedures will be taken to minimize the 
possibility of a breach in confidentiality.  No subjects will be identified in any publication or report of this 
study. There is no medical risk or risk of physical discomfort from this study. 
 
2 
STUDY OBJECTIVES  
This research project will conduct a pilot study to examine the extent to which informational nudges 
incorporating specific information from a provider’s community into recruitment materials (Aim 1) and 
financial incentives (Aim 2) affect participation in ECHO MAT by primary care providers. Through these 
estimates, this study will contribute much-needed information on the incentives that can be used to 
create a behavioral health workforce that is ready to meet the challenges of the opioid epidemic. 
2.1 
Primary Objective 
Aim 1: To estimate the influence of informational nudges on the engagement of primary care providers 
in an opioid treatment learning collaborative to address the opioid overdose crisis. Primary care 
providers in North Carolina, including physicians, nurse practitioners, and physician assistants, will be 
randomly assigned to receive either a pro-social recruitment approach for participating in the UNC 
ECHO MAT intervention or standard recruitment practice. Treatment assignment will provide pro-social 
information, including customized figures on the opioid use epidemic in the provider’s region and the 

Nudges and Incentives to Enhance the Opioid Treatment Workforce 
 
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degree of the provider shortage in their region. The comparison arm will include a standard approach to 
recruitment that does not contain a pro-social recruitment message. Analysis of this data will provide 
estimates of the degree of responsiveness of providers to informational nudges. 
Aim 2: To estimate the influence of financial incentives on the participation intensity of primary care 
providers in an opioid treatment learning collaborative to address the opioid overdose crisis. At the 
second stage, providers agreeing to enroll in the program will be re-randomized to one of three levels of 
reimbursement for time spent participating in the UNC ECHO MAT intervention. Analysis of this data will 
provide causal estimates of the degree of responsiveness of provider participation intensity to financial 
incentives.  
2.2 
Secondary Objective 
A sub-aim will examine whether the effect of incentives on participation intensity varies between the 
pro-social recruitment group and status-quo recruitment group. 
 
3 
INVESTIGATIONAL PLAN (brief overview) 
3.1 
Study Design 
In the first level of the study, providers will be randomized to receive one of two different recruitment 
letters. The receipt of the letter is the intervention for Aim 1. We will follow providers for up to 6 
months after the mailing of the recruitment letters to monitor whether they attempted to sign up for 
the ECHO learning collaborative. This is the primary outcome for Aim 1. 
 
Among the providers who contacted the study coordinator with interest in participating in the ECHO 
MAT learning collaborative (up to 80 of the providers), we will obtain consent to participate in the 
second level of the study, where providers will be randomized to one of three levels of financial 
reimbursement for their time in the ECHO sessions. This is the intervention for the second level of the 
study. We will monitor the number of sessions attended over 6 months from enrollment (9 months from 
enrollment for participants who did not complete as of 3/9/2020). This is the outcome for the second 
level of the study. We will send a letter to inform participants on how much they have participated and, 
if applicable, their incentive amount. 
 
We may ask up to 44 of the study participants to participate in key informant interviews once their 
participation in the study has ended (6 months after enrollment). We will also contact a few individuals 
who initially indicated they were interested in participating, but then did not complete the consent 
process. We hope to learn why they did not complete the enrollment process. 
 
We will contact study participants to notify them that we will look up their Waiver 2000 status (this is 
available through the DEA and publicly available on SAMHSA's website). We will not post or publish 
individual provider specific information on Waiver status.  
 

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We will use Medicaid claims data and ECHO learning collaborative participation data for the participants 
in our study to examine if the interventions in phase 1 or 2 have changed their MAT prescribing 
behavior, or their participation in ECHO MAT learning collaboratives.  
 
Recruitment:  Primary care providers will receive recruitment letters and may receive emails and 
phone calls based on the recruitment condition they are assigned to.        
Randomization:  
Phase 1: Primary care providers will be randomized by practice to 1 of 4 study arms. Computerized 
randomization will assign practices to study arms, practices and primary care providers will have an 
equal chance of being randomized to each study arm.        
Phase 2: Eligible participants will be randomized to the Phase 2 study arm upon enrollment in the 
study. Randomization will be assigned using a predetermined randomly ordered list of study condition 
assignments. Upon enrolling in the study, the participants will be assigned to the condition that is next 
on the list. Participants will have an equal chance of being randomized to each study arm.  
3.2 
Allocation to Treatment Groups and Blinding (if applicable) 
Participants are randomized to receive 1 of 4 recruitment materials.  Once enrolled, participants are 
then randomized to receive 1 of 3 financial reimbursements for attendance in ECHO sessions 
3.3 
Study Duration, Enrollment and Number of Subjects 
Each subject’s participation will last six months (nine months for subjects who did not complete as of 
3/9/2020 due to the complex practice environment experienced by providers during the start of the 
COVID-19 pandemic). 
The entire study is expected to last up to two years.  
Total number of subjects will be up to 80 as needed to achieve at least 20 subjects in each of the 3 
financial reimbursement groups. 
3.4 
Study Population 
Inclusion Criteria 
1. Licensed practicing Primary Care Provider (MD, DO, PA, NP) 
2. Currently practicing in NC, not currently participating in ECHO MAT 
Exclusion Criteria 
1. Another member of the same practice is already enrolled in the study (one provider per practice in 
Phase 2) 
2. Active participation in The University of North Carolina at Chapel Hill (UNC) ECHO Collaborative at 
beginning of study 
 
 

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4 
STUDY PROCEDURES (what will be done) 
Once a provider is enrolled a schedule of weekly online live UNC ECHO clinic sessions will be sent from 
the UNC ECHO study team.  Attendance is noted at each session and a summary of the prior months’ 
attendance record is sent to the Principal Investigator monthly, indicating the number of hours spent in 
training and the reimbursement for those sessions.  The appropriate dollar amount will be paid to the 
participant through a reloadable Visa gift card. 
 
4.1 
Subject Completion/ Withdrawal procedures 
A primary care provider (subject) can participate in as many or as few ECHO MAT sessions as they like 
during the six-month enrollment in the Nudges study (nine month enrollment for participants who do 
not complete as of 3/9/2020), and can continue to participate in ECHO MAT even after completing the 
Nudges enrollment period. Nudges enrollment is based only on time since initial enrollment. A subject 
may withdraw (or be withdrawn) from the Nudges study for any reason. The reason for subject 
withdrawal from the study will be recorded.  
 
5 
STUDY EVALUATIONS AND MEASUREMENTS (how measurements will be made)   
See Table 1 in Appendix. 
 
6 
STATISTICAL CONSIDERATIONS    
 
6.1 
Statistical Methods 
In Aim 1, we anticipate starting with a random selection of 600 providers from the list of eligible NC 
providers received from the NC Board of Medicine and NC Nursing Board, limiting to primary care 
providers identified as primary care through their provider type, which gives more than 90% power to 
detect a ten percentage point difference in the binary outcome, response to study recruitment. We will 
use binary models (logit, linear probability models) to examine response to recruitment as a function of 
study arm, controlling for provider type and county fixed effects.    
For Aim 2, we will randomly recruit at least 60 enrollees (and up to 80 to enroll at least 20 providers per 
arm of this phase).   The outcome to be monitored for Aim 2 is the number of ECHO sessions attended in 
the 6 months following randomization. Because this is a pilot study, the sample size is not powered for 
the primary outcome, number of ECHO clinics attended.  We will conduct a negative binomial or other 
count data model (depending on statistical tests) of the number of sessions as a function of financial 
incentive arm to estimate the effect of financial incentives on participation. 
 

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7 
STUDY INTERVENTION  
See Table 2 in Appendix 
8 
STUDY INTERVENTION ADMINISTRATION  
Phase 1 recruitment letters are designed in a 2 (prosocial mention of need for primary care providers 
trained in opioid use disorder treatment vs. none) x 2 (mention of additional financial supports available 
for participation in training vs. none). This yields 4 study conditions for recruitment letters:  
1) Letter including prosocial messages and additional mention of practice supports available for 
participation,  
2) Letter including prosocial messages but no additional mention of financial support available for 
participation,  
3) Letter including an additional mention of financial support available for participation but no       
prosocial messages, and  
4) Recruitment as usual letter that does not include prosocial messages or an additional mention of 
financial support available for participation.        
Phase 2 examines participation in the learning community by group. Participants will be randomly 
assigned to 1 of 3 groups. The investigators are not disclosing the Phase 2 conditions until the end of the 
study, as approved by UNC's institutional review board (IRB). 
At the end of data collection, we will send a debriefing form to all participants to share the information 
that we withheld from them at the beginning of the study. 
 
9 
SAFETY MANAGEMENT 
There is no medical risk or risk of physical discomfort from this study.  The risk to participants is minimal, 
and this does not meet the definition of a clinical trial, thus there is no data safety monitoring plan. 
 
10 
DATA COLLECTION AND MANAGEMENT  
Procedures will be taken to minimize the possibility of a breach in confidentiality.  No subjects will be 
identified in any publication or report of this study.  
 
The nature of practice level data is ordinary, and unlikely to include socially stigmatizing conditions for 
providers. Secondary claims data will also be stored in secure databases. All working files are limited data 
sets, with patient names and contact information stripped off, but containing identified information on 
providers using a unique identifier (NPI) allowing linkage to data sources such as Medicaid prescribing 
information. This file will remain with the PI; the other research staff will access only files without patient 
names, addresses and other direct identifiers. 
 

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11 
RECRUITMENT STRATEGY 
PCPs will be identified from provider lists obtained through the NC Medical Board for physicians and 
physician assistants and the NC Board of Nursing for nurse practitioners. We will also use the DATA-2000 
database of providers to help us identify PCPs who do not have waivers.  Providers who are prescribing to 
Medicaid beneficiaries will be determined from NC Medicaid claims data, which is in use for the ECHO 
MAT study, and has been IRB approved for re-use for the ECHO Nudges study. We will use the list of 
providers currently participating in ECHO MAT, available to study investigators, to exclude the providers 
currently participating in ECHO (n=24).  Once the denominator of eligible providers has been determined, 
the ECHO Nudges study team will randomly select providers in groups of 600 to randomize for pro-social 
or recruitment as usual invitations to participate in ECHO Nudges (and therefore ECHO MAT). From the 
group who decide to participate (outcome for Aim 1), we will re-randomize to one of the three arms of 
financial incentives. Effort to recruit providers for the Aim 2 analysis will follow immediately from the Aim 
1 retention effort (e.g., providers must agree to participate in ECHO to be randomized to Aim 2). The 
number of sessions of participation within six months of engagement will be the Aim 2 outcome, thus no 
further efforts on retention will be utilized for the ECHO Nudges study.   
 
12 
CONSENT PROCESS 
The project coordinator and/or the study team will give study information in both verbal and written 
form to each potential (provider) participant. Potential research participants are primary care providers 
in NC (MDs, DOs, NP, PAs). No patient identifying information will be collected through this effort. The 
consent form generated for enrolling PCPs by the investigators will be approved (along with the protocol) 
by UNC’s IRB.  Consent will be documented by the dated signature of the participant or the participant’s 
legally authorized representative. The signature confirms that the consent is based on information that 
has been understood.  Each participant’s signed informed consent form will be kept on file by the 
investigators for possible inspection by regulatory authorities. 
Since it is not possible to consent before recruitment to Aim 1, participants will complete the informed 
consent process at the beginning of Phase 2 of the study. The consent form will be shared with eligible 
participants when they contact the study team to enroll. Before enrolling in ECHO Nudges, participants 
will be asked to provide consent.        
We will alter informed consent by only disclosing the study condition to which participants have been 
randomly assigned, and not the alternative Aim 2 treatment assignments, thus withholding the true 
purpose of the study, including the CT.gov #. This is because the aim of the second phase of the study is 
to test the hypothesis that compensating providers for time spent in MAT training increases the time 
they spend training. If we disclose that participants are randomly assigned to receive study incentives or 
not, and different amounts. That knowledge alone could lead to differential involvement in the study, 
which would make it impossible to test the hypothesis. 
 
 

Nudges and Incentives to Enhance the Opioid Treatment Workforce 
 
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13 
PLANS FOR PUBLICATION 
We will disseminate our findings by systematically distributing information through multiple channels 
and users.  We will ensure that it is oriented to the needs of users; utilizes diverse dissemination 
methods with written, oral and electronic media; and maximizes existing and new relationships, thus 
informing all networks about research study results.  Our previous policy work in behavioral health 
policy has been successfully disseminated in regional, national, and international settings.  Our research 
project meetings will include a quarterly dissemination discussion in which we will consider stakeholder 
user needs, emerging project and research findings, and places where stronger relationships and 
linkages are needed. 
 
 

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APPENDIX 
Table 1:  Study Evaluations and Measurements 
Type 
Name 
Time Frame 
Brief Description 
Primary 
Number of 
recruited 
providers that 
contact staff 
for information 
about enrolling 
in the study 
From start of recruitment to end of data 
collection for last participant, up to 1.5 
years 
Phase 1 recruitment interventions 
will be compared based on the 
number of recruited providers that 
reach out to study staff via email, 
phone, or any other method. 
Secondary 
Number of 
recruited 
providers that 
complete 
enrollment in 
the study  
From start of recruitment to enrollment 
fulfillment, up to 1 year 
Phase 1 recruitment interventions 
will be compared based on the 
number of recruited providers that 
enroll in the study. 
Primary 
Number of 
UNC ECHO 
clinic sessions a 
participant 
attends 
Study follow up period (from enrollment 
to 6 months after enrollment; for 
participants who had not completed as 
of 3/9/2020 the 6 months was extended 
by 3 months due to decreased ECHO 
clinic sessions because of COVID-19) 
Phase 2 study interventions will be 
compared based on the number of 
UNC ECHO clinic sessions that a 
participant attends. 
Secondary 
Total amount 
of time a 
participant 
attends a UNC 
ECHO clinic 
session 
Study follow up period (from enrollment 
to 6 months after enrollment; for 
participants who had not completed as 
of 3/9/2020 the 6 months was extended 
by 3 months due to decreased ECHO 
clinic sessions because of COVID-19) 
Phase 2 study interventions will be 
compared based on the total 
amount of time that a participant 
attends a UNC ECHO clinic session 
(P2) 
Secondary 
Number of 
participants 
that receive a 
DATA 2000 
waiver 
Study follow up period (from enrollment 
to 6 months after enrollment; for 
participants who had not completed as 
of 3/9/2020 the 6 months was extended 
by 3 months due to decreased ECHO 
clinic sessions because of COVID-19) 
Phase 2 study interventions will be 
compared based on the number of 
participants that receive a DATA 
2000 waiver. MAT waiver training is 
an 8-hour course for physicians and 
a 24 hour course for advanced 
practitioners that is required for 
providers to prescribe and dispense 
MAT. 
Secondary 
Number of 
participants 
that begin 
prescribing 
MAT paid by 
Medicaid 
Study follow up period (from enrollment 
to 6 months after enrollment; for 
participants who had not completed as 
of 3/9/2020 the 6 months was extended 
by 3 months due to decreased ECHO 
clinic sessions because of COVID-19) 
Phase 2 study interventions will be 
compared based on the number of 
participants that begin prescribing 
MAT. 
 
 
 

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Table 2:  Interventions for Aim 1 
Type 
Name 
Description 
Behavioral (e.g., 
Psychotherapy, 
Lifestyle Counseling) 
Phase 1 Condition 1 
Providers assigned to this condition will be sent 
recruitment materials that are 'recruitment as usual' 
(Phase 1 Condition 1). These materials will not 
include prosocial messaging and will not include an 
additional mention of financial support available for 
participation. 
Behavioral (e.g., 
Psychotherapy, 
Lifestyle Counseling) 
Phase 1 Condition 2 
Providers assigned to this condition will be sent 
recruitment materials that include an additional 
mention of financial support available for 
participation but will not include prosocial messaging 
(Phase 1 Condition 2). 
Behavioral (e.g., 
Psychotherapy, 
Lifestyle Counseling) 
Phase 1 Condition 3 
Providers assigned to this condition will be sent 
recruitment materials that include prosocial 
messaging, but do not include an additional mention 
of financial support available for participation (Phase 
1 Condition 3). 
Behavioral (e.g., 
Psychotherapy, 
Lifestyle Counseling) 
Phase 1 Condition 4 
Providers assigned to this condition will be sent 
recruitment materials that include prosocial 
messaging and an additional mention of financial 
support available for participation (Phase 1 Condition 
4). 
Behavioral (e.g., 
Psychotherapy, 
Lifestyle Counseling) 
Phase 2 Condition 1 
Providers who enroll in the study and are assigned to 
this condition will be in this group. The investigators 
are not disclosing the phase 2 conditions until the 
end of the study. 
Behavioral (e.g., 
Psychotherapy, 
Lifestyle Counseling) 
Phase 2 Condition 2 
Providers who enroll in the study and are assigned to 
this condition will be in this group. The investigators 
are not disclosing the phase 2 conditions until the 
end of the study. 
Behavioral (e.g., 
Psychotherapy, 
Lifestyle Counseling) 
Phase 2 Condition 3 
Providers who enroll in the study and are assigned to 
this condition will be in this group. The investigators 
are not disclosing the phase 2 conditions until the 
end of the study.