Abstract
BackgroundDespite compelling evidence of the benefits of treatment and well-accepted guidelines for treatment, hypertension is controlled in less than one-half of United States citizens.Methods/designThis randomized controlled trial tests whether explicit financial incentives promote the translation of guideline-recommended care for hypertension into clinical practice and improve blood pressure (BP) control in the primary care setting. Using constrained randomization, we assigned 12 Veterans Affairs hospital outpatient clinics to four study arms: physician-level incentive; group-level incentive; combination of physician and group incentives; and no incentives (control). All participants at the hospital (cluster) were assigned to the same study arm. We enrolled 83 full-time primary care physicians and 42 non-physician personnel. The intervention consisted of an educational session about guideline-recommended care for hypertension, five audit and feedback reports, and five disbursements of incentive payments. Incentive payments rewarded participants for chart-documented use of guideline-recommended antihypertensive medications, BP control, and appropriate responses to uncontrolled BP during a prior four-month performance period over the 20-month intervention. To identify potential unintended consequences of the incentives, the study team interviewed study participants, as well as non-participant primary care personnel and leadership at study sites. Chart reviews included data collection on quality measures not related to hypertension. To evaluate the persistence of the effect of the incentives, the study design includes a washout period.DiscussionWe briefly describe the rationale for the interventions being studied, as well as the major design choices. Rigorous research designs such as the one described here are necessary to determine whether performance-based payment arrangements such as financial incentives result in meaningful quality improvements.Trial Registrationhttp://www.clinicaltrials.govNCT00302718
Highlights
Despite compelling evidence of the benefits of treatment and well-accepted guidelines for treatment, hypertension is controlled in less than one-half of United States citizens
Rigorous research designs such as the one described here are necessary to determine whether performance-based payment arrangements such as financial incentives result in meaningful quality improvements
In this paper, we describe our rationale, methods, and baseline participant characteristics for a cluster-randomized trial to assess the effectiveness of pay for performance in improving hypertension control and use of guideline-recommended medications in the primary care setting
Summary
We describe our rationale, methods, and baseline participant characteristics for a cluster-randomized trial to assess the effectiveness of pay for performance in improving hypertension control and use of guideline-recommended medications in the primary care setting. As part of the VA Healthcare Personnel Enhancement Act of 2004 (implemented in 2006) [28], the VA healthcare system instituted a new payment system that includes performance pay based on the accomplishment of specific clinical quality goals and objectives which may be established at the local, network, or national level This program provides financial incentives for improvements in quality of care, the specific measures (i.e., hypertension control, diabetes management, colorectal cancer screening) for which payments are given have not been implemented uniformly across VA facilities. We have given a brief description of the rationale for the interventions being studied in this trial of pay for performance, as well as some of the design choices Rigorous research designs such as this one are necessary to determine whether performance-based payment arrangements result in meaningful quality improvements. In this large cluster-RCT of pay for performance, we are seeking to provide such evidence for one of the most common chronic conditions affecting US citizens
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
