CANCER PREVENTION FOR MINORITY WOMEN IN A MEDICAID HMO

这项重新提交的报告提出了一项随机对照试验，以评估 定期反馈和财政奖励制度对以下方面的影响 医生对HealthPass癌症筛查指南的遵从性， 费城的医疗补助医疗保健组织。这项研究将调查是否 每六个月向初级保健站点提供反馈，当链接时 一项特别基于癌症程度的财务奖励计划 预防措施的提供，改善了初级保健提供者对 对50岁及以上妇女的预防。具体的学习问题是： 1)干预是否改变了对筛查指南的遵守情况 乳房检查、乳房X光检查、宫颈涂片和粪便潜血 测试，如果是，在多大程度上；2)这四个组件是 干预对癌症预防的不同影响；3)如何 干预对提供商行为的影响是否迅速；以及，4)如何 对于不同类型的提供者，影响的大小是否有所不同 和/或病人？大约100个初级保健站点参与了 HealthPass将被随机分配到试验组或对照组。 这两个小组的网站将在两年内每六个月审计一次， 使用HealthPass的审计工具和程序。癌症依从性 筛选指南将使用计算机评分来确定 算法。试验组网站将收到详细的反馈意见 他们每六个月的表现，以及表现良好和/或 显著提高将获得财务奖金。这项研究是 之所以意义重大，有几个原因：它侧重于使用金融 鼓励提高护理质量，而不是限制使用 并控制成本；它使用前瞻性、随机化设计；它寻求 改善对传统上服务不足的少数群体的预防； 而且，它是在一个被认为是 为贫困和未参保人员提供护理的主要模式。

This resubmission proposes a randomized controlled trial to assess the impact of a system of periodic feedback and financial incentives on physician compliance with cancer screening guidelines in HealthPASS, Philadelphia's Medicaid HMO. The study will investigate whether the provision of feedback to primary care sites every six months, when linked to a financial bonus program specifically based on the extent of cancer prevention provided, improves on primary care provider attention to prevention for women ages 50 and over. The specific study questions are: 1) does the intervention change adherence to screening guidelines for breast examination, mammography, pap smear, and fecal occult blood testing, and, if so, to what extent; 2) are these four components of cancer prevention affected differently by the intervention; 3) how quickly does the intervention impact on provider behavior; and, 4) how does the magnitude of the effect differ for different types of providers and/or patients? Approximately 100 primary care sites participating in HealthPASS will be randomly assigned to an experimental or control group. Sites in both groups will be audited once every six months for two years, using HealthPASS' auditing tools and procedures. Compliance with cancer screening guidelines will be determined using computerized scoring algorithms. Experimental group sites will receive detailed feedback on their performance every six months, and sites which perform well and/or improve significantly will receive financial bonuses. The study is significant for several reasons: it focuses on using financial incentives to improve quality of care, rather than to limit utilization and control costs; it uses a prospective, randomized design; it seeks to improve prevention for a traditionally under-served minority population; and, it is being undertaken in a setting which is considered one of the major models for providing care for the indigent and uninsured.