Financial team incentives improved recording of diagnoses in primary care: a quasi-experimental longitudinal follow-up study with controls

BMC Research Notes

Anna Maria Heikkinen¹  Lasse Suominen²  Marko Raina³  Jouko Kallio²  Timo Kauppila⁴  Tuomo Lehtovuori² 

[1] Department of Oral and Maxillofacial Diseases, University of Helsinki, Espoo, Finland;Espoo, Finland;Vantaa, Finland;Department of General Practice and Primary Healthcare, HUS, Institute of Clinical Medicine, University of Helsinki, Tukholmankatu 8 B, Vantaa, 00014, Finland

关键词: Group bonus;    Primary care;    Financial incentive;   

Others  :  1232679
DOI  :  10.1186/s13104-015-1602-1

 received in 2014-10-06, accepted in 2015-10-19,  发布年份 2015

【 摘 要 】

Background

In primary care, financial incentives have usually been directed to physicians because they are thought to make the key decisions in order to change the functions of a medical organization. There are no studies regarding the impact that directing these incentives to all disciplines of the care team (e.g. group bonuses for both nurses and doctors) may have, despite the low frequency with which diagnoses were being recorded for primary care visits to doctors. This study tested the effect of offering group bonuses to the care teams.

Methods

This was a retrospective quasi-experimental study with before-and-after settings and two control groups. In the intervention group, the mean percentage of visits to a doctor for which a diagnosis was recorded by each individual care team (mean team-based percentage of monthly visits to a doctor with recorded diagnoses) and simultaneously the same data was gathered from two different primary care settings where no team bonuses were applied. To study the sustainability of changes obtained with the group bonuses the respective data were derived from the electronic health record system for 2 years after the cessation of the intervention. The differences in the rate of marking diagnoses was analyzed with ANOVA and RM-ANOVA with appropriate post hoc tests, and the differences in the rate of change in marking diagnoses was analyzed with linear regression followed by t-test.

Results

The proportion of doctor visits having recorded diagnoses in the teams was about 55 % before starting to use group bonuses and 90 % after this intervention. There was no such increase in control units. The effect of the intervention weakened slightly after cessation of the group bonuses.

Conclusion

Group bonuses may provide a method to alter clinical practices in primary care. However, sustainability of these interventions may diminish after ceasing this type of financial incentive.

【 授权许可】

   
2015 Lehtovuori et al.

【 图 表 】

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【 参考文献 】

• [1]Gosden T, Forland F, Kristiansen I, Sutton M, Leese B, Giuffrida A, Sergison M, Pedersen L: Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians, CD002215. Cochrane Database Syst Rev. 2000.
• [2]Giuffrida A, Gosden T, Forland F, Kristiansen I, Sergison M, Leese B, Pedersen L, Sutton M: Target payments in primary care: effects on professional practice and health care outcome, CD000531. Cochrane Database Syst Rev. 1999.
• [3]Gené-Badia J, Escaramis-Babiano G, Sans-Corrales M, Sampietro-Colom L, Aguado-Menguy F, Cabezas-Peña C, de Puelles PG: Impact of economic incentives on quality of professional life and on end-user satisfaction in primary care. Health Policy. 2007, 80:2-10.
• [4]Weinberger M, Kirkman MS, Samsa GP, Shortliffe EA, Landsman PB, Cowper PA, Simel DL, Feussner JR: A nurse-coordinated intervention for primary care patients with non-insulin-dependent diabetes mellitus: impact on glycemic control and health-related quality of life. J Gen Intern Med. 1995, 10:59-66.
• [5]Mundinger MO, Kane RL, Lenz ER, Totten AM, Tsai WY, Cleary PD, Friedewald WT, Siu AL, Shelanski ML: Primary care outcomes in patients treated by nurse practitioners or physicians: a randomized trial. JAMA. 2000, 283:59-68.
• [6]Doran T, Fullwood C, Kontopantelis E, Reeves D: Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework. Lancet. 2008, 372:728-736.
• [7]Doran T, Kontopantelis E, Valderas JM, Campbell S, Roland M, Salisbury C, Reeves D: Effect of financial incentives on incentivised and non-incentivised clinical activities: longitudinal analysis of data from the UK quality and outcomes framework. BMJ. 2011, 342:d3590.
• [8]Kontopantelis E, Reeves D, Valderas JM, Campbell S, Doran T: Recorded quality of primary care for patients with diabetes in England before and after the introduction of a financial incentive scheme: a longitudinal observational study. BMJ Qual Saf. 2013, 22:53-64.
• [9]McLintock K, Russell AM, Alderson SL, West R, House A, Westerman K, Foy R: The effects of financial incentives for case finding for depression in patients with diabetes and coronary heart disease: interrupted time series analysis. BMJ Open. 2014, 4:e005178.
• [10]Harrison MJ, Dusheiko M, Sutton M, Gravelle H, Doran T, Roland M: Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study. BMJ. 2014, 349:g6423.
• [11]Kontopantelis E, Springate D, Reeves D, Ashcroft DM, Valderas JM, Doran T: Withdrawing performance indicators: retrospective analysis of general practice performance under UK quality and outcomes framework. BMJ. 2014, 348:g330.
• [12]Kontopantelis E, Springate DA, Ashworth M, Webb RT, Buchan IE, Doran T: Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study. BMJ. 2015, 350:h904.
• [13]Houweling ST, Kleefstra N, van Hateren KJ, Groenier KH, de Meyboom Jong B, Bilo HJ: Can diabetes management be safely transferred to practice nurses in a primary care setting? A randomised controlled trial. J Clin Nurs. 2011, 20:1264-1272.
• [14]Coburn KD, Marcantonio S, Lazansky R, Keller M, Davis N: Effect of a community-based nursing intervention on mortality in chronically ill older adults: a randomized controlled trial. PLoS Med. 2012, 9:e1001265.
• [15]Ketola E, Sipilä R, Mäkelä M, Klockars M: Quality improvement programme for cardiovascular disease risk factor recording in primary care. Qual Health Care. 2000, 9:175-180.
• [16]Giorda CB, Guida P, Avogaro A, Cortese C, Mureddu GF, Corsini A, Comaschi MA, Manzato E, Volpe M, Zito GB, Medea G, Ventriglia G, Titta G, Riccardi G: EFFECTUS steering committee. association of physicians’ accuracy in recording with quality of care in cardiovascular medicine. Eur J Cardiovasc Prev Rehabil. 2009, 16:722-728.
• [17]Fleming DM, Schellevis FG, Paget WJ: Health monitoring in sentinel practice networks: the contribution of primary care. Eur J Public Health. 2003, 13(3 Suppl):80-84.
• [18]Hjerpe P, Merlo J, Ohlsson H, Bengtsson Boström K, Lindblad U: Validity of registration of ICD codes and prescriptions in a research database in Swedish primary care: a cross-sectional study in Skaraborg primary care database. BMC Med Inform Decis Mak. 2010, 10:23. BioMed Central Full Text
• [19]Kantonen J, Kaartinen J, Mattila J, Menezes R, Malmila M, Castren M, Kauppila T: Impact of ABCDE triage on the number of patient visits to an emergency unit and to other parts of health care system: a controlled study. BMC Emerg Med. 2010, 10:12. BioMed Central Full Text
• [20]Berenberg RA, Forman DS, Wood DK, De Silva , Demaree J: Recovery of peripheral nerve after axotomy. Exp Neurol. 1977, 57:349-363.
• [21]Kauppila T, Stenberg D: α-Difluoromethylornithine (DMFO) disturbed the sensorimotor functional recovery from a sciatic lesion. Neurosci Lett. 1989, 104:121-124.
• [22]Kontopantelis E, Buchan I, Reeves D, Checkland K, Doran T: Relationship between quality of and choice of clinical computing system: retrospective analysis of family practice performance under the UK’s quality and outcomes framework. BMJ Open. 2013, 3:e003190.
• [23]Rosenthal MB, Frank RG, Li Z, Epstein AM: Early experience with pay-for-performance. From concept to practice. JAMA. 2005, 294:1788-1793.
• [24]Kirschner K, Braspenning J, Jacobs JE, Grol R: Design choices made by target users for a pay-for-performance program in primary care: an action research approach. BMC Fam Pract. 2012, 13:25. BioMed Central Full Text
• [25]Kirschner K, Braspenning J, Akkermans RP, Jacobs JE, Grol R: Assessment of a pay-for-performance program in primary care designed by target users. Fam Pract. 2012, 30:161-171.
• [26]Unützer J, Chan YF, Hafer E, Knaster J, Shields A, Powers D, Veith RC: Quality improvement with pay-for-performance incentives in integrated behavioral health care. Am J Public Health. 2012, 102:e41-e45.
• [27]Scott A, Sivey P, Ait Ouakrim D, Willenberg L, Naccarella L, Furler J, Young D: The effect of financial incentives on the quality of health care provided by primary care physicians CD008451. Cochrane Database Syst Rev. 2011.
• [28]Goudswaard AN, Lam K, Stolk RP, Rutten GEHM: Quality of recording of data from patients with type 2 diabetes is not a valid indicator of quality of care. A cross-sectional study. Fam Pract. 2003, 20:173-177.
• [29]Campbell SM, Reeves D, Kontopantelis E, Sibbald B, Roland M: Effects of pay for performance on the quality of primary care in England. N Engl J Med. 2009, 361:368-378.
• [30]Kamb ML, Rhodes F, Hoxworth T, Rogers J, Lentz A, Kent C, MacGowen R, Peterman TA: What about money? Effect of small monetary incentives on enrollment, retention, and motivation to change behaviour in an HIV/STD prevention counselling intervention. The Project RESPECT Study Group. Sex Transm Infect. 1998, 74:253-255.