Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
University Hospital Zurich, Zürich, Switzerland.
J Gen Intern Med. 2022 Feb;37(3):556-564. doi: 10.1007/s11606-021-06714-8. Epub 2021 Apr 26.
Financial incentives are often used to improve quality of care in chronic care patients. However, the evidence concerning the effect of financial incentives is still inconclusive.
To test the effect of financial incentives on quality measures (QMs) in the treatment of patients with diabetes mellitus in primary care. We incentivized a clinical QM and a process QM to test the effect of financial incentives on different types of QMs and to investigate the spill-over effect on non-incentivized QMs.
DESIGN/PARTICIPANTS: Parallel cluster randomized controlled trial based on electronic medical records database involving Swiss general practitioners (GPs). Practices were randomly allocated.
All participants received a bimonthly feedback report. The intervention group additionally received potential financial incentives on GP level depending on their performance.
Between-group differences in proportions of patients fulfilling incentivized QM (process QM of annual HbA1c measurement and clinical QM of blood pressure level below 140/95 mmHg) after 12 months.
Seventy-one GPs (median age 52 years, 72% male) from 43 different practices and subsequently 3838 patients with diabetes mellitus (median age 70 years, 57% male) were included. Proportions of patients with annual HbA1c measurements remained unchanged (intervention group decreased from 79.0 to 78.3%, control group from 81.5 to 81.0%, OR 1.09, 95% CI 0.90-1.32, p = 0.39). Proportions of patients with blood pressure below 140/95 improved from 49.9 to 52.5% in the intervention group and decreased from 51.2 to 49.0% in the control group (OR 1.16, 95% CI 0.99-1.36, p = 0.06). Proportions of non-incentivized process QMs increased significantly in the intervention group.
GP level financial incentives did not result in more frequent HbA1c measurements or in improved blood pressure control. Interestingly, we could confirm a spill-over effect on non-incentivized process QMs. Yet, the mechanism of spill-over effects of financial incentives is largely unclear.
ISRCTN13305645.
经济激励措施常被用于提高慢性病患者的医疗质量。然而，关于经济激励对医疗质量影响的证据仍不明确。
测试经济激励措施对初级保健中治疗糖尿病患者的质量指标（QMs）的影响。我们激励了一个临床 QM 和一个流程 QM，以测试经济激励对不同类型 QMs 的效果，并调查对非激励 QMs 的溢出效应。
设计/参与者：基于电子病历数据库的平行集群随机对照试验，涉及瑞士全科医生（GPs）。实践随机分配。
所有参与者每月收到两次反馈报告。干预组还根据表现获得潜在的 GP 层面的经济激励。
12 个月后，激励性 QM（年度 HbA1c 测量的流程 QM 和血压水平低于 140/95mmHg 的临床 QM）的患者比例在组间的差异。
71 名全科医生（中位数年龄 52 岁，72%为男性）来自 43 个不同的实践，随后有 3838 名糖尿病患者（中位数年龄 70 岁，57%为男性）纳入研究。年度 HbA1c 测量的患者比例保持不变（干预组从 79.0%下降至 78.3%，对照组从 81.5%下降至 81.0%，OR 1.09，95%CI 0.90-1.32，p = 0.39）。血压低于 140/95mmHg 的患者比例在干预组从 49.9%上升至 52.5%，对照组从 51.2%下降至 49.0%（OR 1.16，95%CI 0.99-1.36，p = 0.06）。激励性流程 QMs 的非激励比例在干预组显著增加。
GP 层面的经济激励并未导致更频繁的 HbA1c 测量或血压控制的改善。有趣的是，我们可以确认对非激励性流程 QMs 的溢出效应。然而，经济激励溢出效应的机制在很大程度上仍不清楚。
ISRCTN86602582。
