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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

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