CANCER PREVENTION FOR MINORITY WOMEN IN A MEDICAID HMO

这次重新提交提出了一项随机对照试验来评估 定期反馈和财务激励制度的影响 医生遵守 HealthPASS 中的癌症筛查指南， 费城的医疗补助 HMO。 该研究将调查是否 每六个月向初级保健站点提供反馈（链接时） 专门根据癌症程度制定的财务奖励计划 提供预防，提高初级保健提供者对 50岁以上女性的预防。 具体研究问题是： 1) 干预措施是否会改变对筛查指南的遵守 乳房检查、乳房X光检查、子宫颈抹片检查和粪便潜血 测试，如果是，测试的程度如何； 2）这四个组成部分是 干预措施对癌症预防的影响不同； 3）如何 干预措施对提供者的行为是否会产生快速影响；以及，4）如何 不同类型的提供商的影响程度是否不同 和/或患者？ 大约 100 个初级保健机构参与 HealthPASS 将被随机分配给实验组或对照组。 两个组的站点将在两年内每六个月审核一次， 使用 HealthPASS 的审核工具和程序。 癌症的依从性 筛选指南将使用计算机评分确定 算法。 实验组网站将收到详细的反馈 他们每六个月的表现，以及表现良好的网站和/或 显着改善将获得财务奖金。 该研究是 其重要性有几个原因：它侧重于利用财务 提高护理质量的激励措施，而不是限制使用 并控制成本；它采用前瞻性随机设计；它力求 改善对传统上服务不足的少数群体的预防； 并且，它是在被认为是最重要的环境之一的环境中进行的 为贫困者和无保险者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.