Financial Incentives to Translate ALLHAT Into Practice: A Randomized Trial
Summary
The purpose of this study is to determine whether financial incentives for guideline-recommended treatment of hypertension are effective. We hypothesize that patients with hypertension cared for by physicians or physician groups receiving financial incentives will be more likely to be prescribed guideline-recommended anti-hypertensive medications and achieve JNC-7 guideline-recommended blood pressure goals compared to patients who are treated by providers that do not receive any financial incentives.
Description
Background:
Despite compelling evidence of the benefits of treatment, hypertension is controlled in less than one-quarter of US citizens. Using a cluster randomized controlled trial, we will test the effect of explicit physician-level and group-level financial incentives to promote the provision of guideline-recommended anti-hypertensive medications and improved control of hypertension in the VA primary care setting.
Objectives:
The goals are to: (1) determine the effect of physician-level financial incentives on processes and outcomes of care for outpatients with hypertension; (2) assess the impact of group-level incentives; (3) ascertain whether there are additive or synergistic effects of physician+group-level incentives; (4) evaluate the persistence of the effect of incentives after the intervention ceases; and (5) identify any negative impacts of incentives on patients, providers, or health care organizations.
Methods:
Primary care physicians from 12 VA hospitals will be randomized to the following arms: (1) physician-level incentive; (2) group-level incentive; (3) physician+group incentives; and (4) audit and feedback only. Study sites in the group only and provider+group will include non-physician participants (e.g., nurses). Outcomes include the use of guideline-recommended anti-hypertension medications and the proportion of patients who achieve national (JNC 7) guideline-recommended blood pressure goals or receive appropriate treatment in response to an elevated blood pressure reading. Cross-sectional analyses at 3 time points will be used to compare the effect of the interventions, with audit and feedback to all study participants at 5 time points over the intervention period. Data on comorbid conditions, treatment, medications, and blood pressure will be collected from a sample of each physician's practice. We will use analytic methods appropriate for a cluster-randomized trial, as patients are nested within physicians, who are further nested in hospitals.
Status:
We are currently collecting data via chart abstraction from 2,840 charts for Period 5. We are assessing participants' performance from April 1-July 31, 2009. We anticipate providing audit and feedback along with incentive awards for Period 5 in February 2010.
Study Design
Allocation: Randomized, Control: Active Control, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Health Services Research
Conditions
Hypertension
Intervention
Physician-level financial incentive, Group-level financial incentive, Physician and group-level financial incentives
Location
VA Medical Center, Birmingham
Birmingham
Alabama
United States
35233
Status
Active, not recruiting
Source
Department of Veterans Affairs
Results (where available)
Links
- Source: http://clinicaltrials.gov/show/NCT00302718
- Information obtained from ClinicalTrials.gov on July 15, 2010
Medical and Biotech [MESH] Definitions
Financial Audit
An examination, review and verification of all financial accounts.
Poverty
A situation in which the level of living of an individual, family, or group is below the standard of the community. It is often related to a specific income level.
Physician Self-referral
Referral by physicians to testing or treatment facilities in which they have financial interest. The practice is regulated by the Ethics in Patient Referrals Act of 1989.
Hospital-physician Joint Ventures
A formal financial agreement made between one or more physicians and a hospital to provide ambulatory alternative services to those patients who do not require hospitalization.
Provider-sponsored Organizations
Entities sponsored by local hospitals, physician groups, and other licensed providers which are affiliated through common ownership or control and share financial risk whose purpose is to deliver health care services.
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