Regular articleThe impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines☆
Section snippets
Background
The recent Institute of Medicine Report, Crossing the Quality Chasm: A New Health System for the 21st Century [1], issued a broad call for redesigning the health care system, in order to better meet patients’ needs and improve outcomes. To accomplish this goal health care organizations are charged with identifying managerial strategies that facilitate the creation of care environments or organizational support systems that ensure optimal care delivery by, for example, increased provider
Design
A three-condition group randomized efficient (unbalanced) evaluation design was employed. The three experimental conditions are represented by (1) no intervention/ control (distribution of printed versions of the smoking cessation guidelines) (“control”), (2) financial incentives for reaching preset clinical performance targets (“incentive”), and (3) financial incentives for reaching preset clinical performance targets combined with access to a centralized smoker registry and intervention
Organizational support process i: financial incentives for reaching preset clinical performance targets
The medical group’s management decided to set and communicate clinical performance targets that would trigger a pay-out of financial incentives if reached. Management decided that 75% of all patients over 18 should have their tobacco status clearly identified at each visit and documented in their medical records for their last; and 65% of smokers should have provision of advice to quit smoking documented in their medical record for the last visit to trigger incentive payout for a clinic.
Practice pattern end points
At baseline no differences were found between the experimental conditions with respect to identification of tobacco use, provision of advice to quit, and assistance in quitting (i.e., information about or prescription for smoking cessation aids) at the most recent clinic visit. Rates of these practice patterns improved dramatically between Summer 1999 and Summer 2000. Overall, identification of smokers at the most recent visit, advising smokers to quit, and providing assistance to quit improved
Discussion
This study evaluated the effects of two promising but understudied organizational support processes hypothesized to impact improvement in preventive care quality. The organizational support processes are represented by financial incentives for meeting preset clinical practice targets and coupling a patient (smoker) registry and telephone intervention system with targeted clinical practices. Specifically, their impact on the improvement of clinical smoking cessation practices and associated
Acknowledgements
This study was supported in part by a grant from the Robert Wood Johnson Foundation (Grant 036023). The investigators are grateful to Allina Hospitals & Clinics and the management and staff of the Allina Medical Clinic in their support of this effort. The following Allina Medical Clinic sites generously participated in the efforts described in this manuscript: Annandale, Buffalo, Cambridge, Champlin, Cokato, Coon Rapids Family Practice, Coon Rapids Internal Medicine, Coon Rapids Women’s Health,
References (22)
Financial incentives for ambulatory care performance improvement
Jt Comm J Qual Improv
(1999)- et al.
Telephone counseling as adjuvant treatment for nicotine replacement therapy in a “real-world” setting
Prev Med
(2000) - et al.
Lessons from experienced guideline implementersattend to many factors and use multiple strategies
Jt Comm J Qual Improv
(2000) Crossing the quality chasma new health system for the 21st century
(2001)- et al.
Five-hundred life saving intervention and their cost effectiveness
Risk Anal
(1995) - et al.
National patterns in the treatment of smokers by physicians
JAMA
(1998) A clinical practice guideline for treating tobacco use and dependencea US Public Health Service report
JAMA
(2000)- et al.
Changing physicians’ practices
N Engl J Med
(1993) - et al.
The impact of financial incentives on quality of health care
Milbank Q
(1998) - et al.
Impact of payment method on behavior of primary care physiciansa systematic review
J Health Serv Res Pol
(2001)
Improving physician’s preventive health care behavior through peer review and financial incentives
Arch Fam Med
Cited by (150)
Symptom Status of Patients Undergoing Carotid Endarterectomy in Canada and United States
2022, Annals of Vascular SurgeryCitation Excerpt :Amendments of reimbursement models to account for symptomatic status and adjunctive procedures may improve standardization of evidence-based care. For example, changes in compensation models have improved guideline adherence in the management of diabetes36 and smoking cessation.37 In terms of medical therapy, the use of aspirin and statin for carotid stenosis is a Grade 1A recommendation by SVS, ESVS, and AHA due to significant mortality and morbidity benefit.2–4,38,39
An analysis of adaptations to multi-level intervention strategies to enhance implementation of clinical practice guidelines for treating tobacco use in dental care settings
2018, Contemporary Clinical Trials CommunicationsCitation Excerpt :This analysis was conducted in the context of a three-arm cluster randomized controlled trial, the DUET (Dentists United to Extinguish Tobacco) Project, that evaluated system-level strategies for implementing practice guidelines for TDT in 18 dental health clinics from 2013 to 2017. These strategies included: ARM 1) Staff training and current best practices (CBP) which included a chart system to prompt tobacco use screening, brief counseling and cessation pharmacotherapy, and a system to refer patients to cessation counseling resources; ARM 2) CBP + performance feedback (PF); and ARM 3) CBP + PF + pay for performance (P4P) [8–17]. Table 1 describes the characteristics of participating clinics and dental providers.
Comparison of pay-for-performance (P4P) programs in primary care of selected countries: a comparative study
2023, BMC Health Services Researchassessment of activities and participation of people by rehabilitation-focused clinical registries: a systematic scoping review
2023, European Journal of Physical and Rehabilitation Medicine
- ☆
Surveys available upon request from corresponding author.