PEDIATRIC PREVENTIVE CARE INCENTIVES IN A MEDICAID HMO

这项随机对照试验将评估一个系统的影响 关于儿科合规的定期反馈和财政激励 强制性医疗补助HealthPass中的预防性护理临床指南 费城的医疗保健组织。这项研究将调查该条款是否 每六个月向网站提交详细的反馈报告，并与 财政奖励计划专门与预防保健挂钩，改善 关于卫生组织目前观察到的儿科标准的符合率 60%。具体的研究问题是：1) 干预改变了对预防性护理指南的遵守，如果是这样的话， 在多大程度上受到影响；2)不同的预防保健组成部分是否受到影响 不同；3)干预对医生的影响有多快 行为；以及，4)影响的大小对 不同类型的提供者实践？大约51名儿科医生 初级保健站点参与HealthPass和会议研究 资格标准将随机分配给试验性或 对照组。这两个组中的站点将每六次进行一次审计 使用HealthPass的审计工具和程序，为期两年。 将确定儿科预防护理指南的遵从性 使用计算机化的评分算法。试验点将收到 每六个月提交一次关于其业绩的详细反馈报告，以及 表现良好和/或显著改善的网站将收到 财务红利。这项研究之所以意义重大，有几个原因：它 专注于使用财务激励来提高质量，而不是 限制使用率；它使用前瞻性、随机化设计，改进 在以前关于激励的研究基础上；它寻求提高人们对 为传统上服务不足的少数群体提供预防性护理；以及 它是在一个被认为是主要的 为贫困和未参保的人提供护理的模式。

This randomized controlled trial will assess the impact of a system of periodic feedback and financial incentives on compliance with pediatric preventive care clinical guidelines in HealthPASS, a mandatory Medicaid HMO in Philadelphia. The study will investigate whether the provision of detailed feedback reports to sites every six months, linked with a financial bonus program specifically tied to preventive care, improves on the HMO's currently observed pediatrics standards compliance rate of 60 percent. The specific research questions are: 1) does the intervention change adherence to preventive care guidelines, and, if so, to what extent; 2) are different preventive care components affected differently; 3) how quickly does the intervention influence physician behavior; and, 4) how does the magnitude of the effect differ for different types of provider practices? Approximately 51 pediatric primary care sites participating in HealthPASS and meeting study eligibility criteria 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 pediatric preventive care guidelines will be determined using computerized scoring algorithms. Experimental sites will receive detailed feedback reports on their performance every six months, and sites which perform well and/or improve substantially will receive financial bonuses. The study is significant for several reasons: it focusses on using financial incentives to improve quality, rather than to limit utilization; it uses a prospective, randomized design, improving on previous research on incentives; it seeks to improve attention to preventive care for a traditionally underserved minority population; and, it is being undertaken in a setting which is considered one of the major models for providing care to the indigent and uninsured.