The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines

This study tested the effects of two organizational support processes, the provision of financial incentives for superior clinical performance and the availability of a patient (smoker) registry and proactive telephone support system for smoking cessation, on provider adherence to accepted practice...

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Bibliographic Details
Published in:Preventive medicine 2003-03, Vol.36 (3), p.291-299
Main Authors: Roski, Joachim, Jeddeloh, Robert, An, Larry, Lando, Harry, Hannan, Peter, Hall, Carmen, Zhu, Shu-Hong
Format: Article
Language:English
Subjects:
Ambulatory Care Facilities - economics
Ambulatory Care Facilities - standards
Evidence-Based Medicine
Female
Guideline Adherence
Health Services Research
Humans
Male
Outcome and Process Assessment (Health Care)
Physician Incentive Plans - economics
Practice guidelines
Practice Guidelines as Topic
Practice management
Preventive Health Services - economics
Preventive Health Services - standards
Preventive medicine
Primary Health Care - economics
Primary Health Care - standards
Probability
Quality of health care
Reference Values
Registries
Reimbursement, Incentive
Smoking cessation
Smoking Cessation - economics
Smoking Cessation - psychology
Smoking Cessation - statistics & numerical data
Social Support
United States
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Summary:This study tested the effects of two organizational support processes, the provision of financial incentives for superior clinical performance and the availability of a patient (smoker) registry and proactive telephone support system for smoking cessation, on provider adherence to accepted practice guidelines and associated patient outcomes. Forty clinics of a large multispecialty medical group practice providing primary care services were randomly allocated to study conditions. Fifteen clinics each were assigned to the experimental conditions “control” (distribution of printed versions of smoking cessation guidelines) and “incentive” (financial incentive pay-out for reaching preset clinical performance targets). Ten clinics were randomized to receive financial incentives combined with access to a centralized patient registry and intervention system (″registry″). Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients’ smoking cessation behaviors. Patients’ tobacco use status was statistically significant ( P < 0.01) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition. Patients visiting registry clinics accessed counseling programs statistically significantly more often ( P < 0.001) than patients receiving care in the control condition. Other endpoints did not statistically significantly differ between the experimental conditions. The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practices and patient behaviors was mixed. Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment.
ISSN:0091-7435
1096-0260
DOI:10.1016/S0091-7435(02)00052-X