Advertisement

Topics

Financial Incentives to Translate ALLHAT Into Practice: A Randomized Trial

2014-08-27 03:45:42 | BioPortfolio

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)

View Results

Links

Published on BioPortfolio: 2014-08-27T03:45:42-0400

Clinical Trials [2913 Associated Clinical Trials listed on BioPortfolio]

Southern California Nutrition Incentive Program

The specific aims of this proposal are to implement SCNIP in 6 Northgate Gonzalez Markets across San Diego, Orange and LA counties (2 in each county), and determine which level of financia...

The Impact of Family Financial Support on Parental Mental Health

We have partnered with financial coaching organizations to establish what we have termed a "Medical-Financial Partnership (MFP)" that offers financial coaching to improve financial and men...

The Impact of Family Financial Support on Cognition

We have partnered with financial coaching organizations to establish what we have termed a "Medical-Financial Partnership (MFP)" that offers financial coaching to improve financial and men...

The Impact of Family Financial Support on Parental Stress

We have partnered with financial coaching organizations to establish what we have termed a "Medical-Financial Partnership (MFP)" that offers financial coaching to improve financial and men...

Enhancing Physical Activity and Weight Reduction Through Smartcare and Financial Incentives

The investigators are planning to conduct a pilot RCT of young obese population to evaluate the effect of smartcare with or without financial incentives for 12 weeks. Participants will be ...

PubMed Articles [20514 Associated PubMed Articles listed on BioPortfolio]

The impact of the 2008/2009 financial crisis on specialist physician activity in Canada.

Fee-for-service physicians are responsible for planning for their retirements, and there is no mandated retirement age. Changes in financial markets may influence how long they remain in practice and ...

Impact of trained oncology financial navigators on patient out-of-pocket spending.

Patients with cancer often face financial hardships, including loss of productivity, high out-of-pocket (OOP) costs, depletion of savings, and bankruptcy. By providing financial guidance and assistanc...

A heterogeneous artificial stock market model can benefit people against another financial crisis.

This paper presents results of an artificial stock market and tries to make it more consistent with the statistical features of real stock data. Based on the SFI-ASM, a novel model is proposed to make...

Clinically Competent and Fiscally at Risk: Impact of Debt and Financial Parameters on the Surgical Resident.

While the costs of medical training continue to increase, surgeon income and personal financial decisions may be challenged to manage this expanding debt burden. We sought to characterize the financia...

Establishing financial literacy: what every resident needs to know.

Financial literacy is a skill that requires an ongoing investment of time and often is overlooked throughout medical training. Physicians are facing an unprecedented student loan burden upon graduatio...

Medical and Biotech [MESH] Definitions

A financial account set up between a financial institution (such as a commercial bank) and a customer (individual, group, or business), whereby the latter may deposit and withdraw money, and where applicable, be paid interest.

An examination, review and verification of all financial accounts.

Formal and structured record of financial activities of a business, person, or other entity.

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.

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.

More From BioPortfolio on "Financial Incentives to Translate ALLHAT Into Practice: A Randomized Trial"

Advertisement
Quick Search
Advertisement
Advertisement

 

Relevant Topics

Cardiology
Cardiology is a specialty of internal medicine.  Cardiac electrophysiology : Study of the electrical properties and conduction diseases of the heart. Echocardiography : The use of ultrasound to study the mechanical function/physics of the h...

Pulmonary Hypertension
Pulmonary arterial hypertension (PAH) is a chronic, life-threatening disorder characterized by abnormally high blood pressure in the arteries between the heart and lungs of affected individuals. Symptoms can range from mild breathles...


Searches Linking to this Trial