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The use of physician financial incentives and feedback to improve pediatric preventive care in Medicaid managed care.
Pediatrics. 1999 Oct; 104(4 Pt 1):931-5.Ped

Abstract

OBJECTIVE

Immunizations and other cost-effective preventive services remain underused by many children, especially those living in poverty. Given the effectiveness of provider-based tracking systems and the widespread use by managed care organizations of financial incentives to influence physician practice patterns, we designed and tested an intervention combining these strategies. We studied whether a system of semiannual assessment and feedback, coupled with financial incentives, could improve pediatric preventive care in a Medicaid health maintenance organization (HMO).

METHODOLOGY

We randomly assigned primary care sites serving children in a Medicaid HMO to one of three groups: a feedback group (where physicians received written feedback about compliance scores), a feedback and incentive group (where physicians received feedback and a financial bonus when compliance criteria were met), and a control group. We evaluated compliance with pediatric preventive care guidelines through semiannual chart audits during the years 1993 to 1995.

RESULTS

Compliance with pediatric preventive care improved dramatically in the study period. Repeated measures ANOVA demonstrated a significant increase in all three study groups throughout the time in total compliance scores (from 56%-73%), as well as scores for immunizations (from 62%-79%) and other preventive care (from 54%-71%). However, no significant differences were observed between either intervention group and the control group, nor were there any interaction (group-by-time) effects.

CONCLUSIONS

Feedback to physicians, with or without financial incentives, did not improve pediatric preventive care in this Medicaid HMO during a time of rapid, secular improvements in care. Possible explanations include the context and timing of the intervention, the magnitude of the financial incentives, and lack of physician awareness of the intervention.

Authors+Show Affiliations

Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia 19104-6021, USA. garnetla@mail.med.upenn.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

10506237

Citation

Hillman, A L., et al. "The Use of Physician Financial Incentives and Feedback to Improve Pediatric Preventive Care in Medicaid Managed Care." Pediatrics, vol. 104, no. 4 Pt 1, 1999, pp. 931-5.
Hillman AL, Ripley K, Goldfarb N, et al. The use of physician financial incentives and feedback to improve pediatric preventive care in Medicaid managed care. Pediatrics. 1999;104(4 Pt 1):931-5.
Hillman, A. L., Ripley, K., Goldfarb, N., Weiner, J., Nuamah, I., & Lusk, E. (1999). The use of physician financial incentives and feedback to improve pediatric preventive care in Medicaid managed care. Pediatrics, 104(4 Pt 1), 931-5.
Hillman AL, et al. The Use of Physician Financial Incentives and Feedback to Improve Pediatric Preventive Care in Medicaid Managed Care. Pediatrics. 1999;104(4 Pt 1):931-5. PubMed PMID: 10506237.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The use of physician financial incentives and feedback to improve pediatric preventive care in Medicaid managed care. AU - Hillman,A L, AU - Ripley,K, AU - Goldfarb,N, AU - Weiner,J, AU - Nuamah,I, AU - Lusk,E, PY - 1999/10/3/pubmed PY - 1999/10/3/medline PY - 1999/10/3/entrez SP - 931 EP - 5 JF - Pediatrics JO - Pediatrics VL - 104 IS - 4 Pt 1 N2 - OBJECTIVE: Immunizations and other cost-effective preventive services remain underused by many children, especially those living in poverty. Given the effectiveness of provider-based tracking systems and the widespread use by managed care organizations of financial incentives to influence physician practice patterns, we designed and tested an intervention combining these strategies. We studied whether a system of semiannual assessment and feedback, coupled with financial incentives, could improve pediatric preventive care in a Medicaid health maintenance organization (HMO). METHODOLOGY: We randomly assigned primary care sites serving children in a Medicaid HMO to one of three groups: a feedback group (where physicians received written feedback about compliance scores), a feedback and incentive group (where physicians received feedback and a financial bonus when compliance criteria were met), and a control group. We evaluated compliance with pediatric preventive care guidelines through semiannual chart audits during the years 1993 to 1995. RESULTS: Compliance with pediatric preventive care improved dramatically in the study period. Repeated measures ANOVA demonstrated a significant increase in all three study groups throughout the time in total compliance scores (from 56%-73%), as well as scores for immunizations (from 62%-79%) and other preventive care (from 54%-71%). However, no significant differences were observed between either intervention group and the control group, nor were there any interaction (group-by-time) effects. CONCLUSIONS: Feedback to physicians, with or without financial incentives, did not improve pediatric preventive care in this Medicaid HMO during a time of rapid, secular improvements in care. Possible explanations include the context and timing of the intervention, the magnitude of the financial incentives, and lack of physician awareness of the intervention. SN - 0031-4005 UR - https://www.unboundmedicine.com/medline/citation/10506237/The_use_of_physician_financial_incentives_and_feedback_to_improve_pediatric_preventive_care_in_Medicaid_managed_care_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=10506237 DB - PRIME DP - Unbound Medicine ER -