Financial Incentives to Translate ALLHAT into Practice

将 ALLHAT 转化为实践的经济激励

• 批准号: 7845807
• 负责人: LAURA A PETERSEN
• 金额: $ 26.78万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2011-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7845807
• 关键词: Administrator; Adopted; Antihypertensive Agents; Awareness; Behavior; Blood Pressure; Caring; Clinical Research; Clinical Trials; Congestive Heart Failure; Coronary Arteriosclerosis; Cost Control; Costs and Benefits; Coupled; Detection; Disease; Evaluation; Feedback; Goals; Guidelines; Health; Health Services; Healthcare; Hospitals; Hypertension; Incentives; Individual; Institute of Medicine (U.S.); Intervention; Joints; Journals; Kidney Failure; Knowledge; LDL Cholesterol Lipoproteins; Lead; Lipids; Measures; Medicare; Methods; Modeling; Myocardial Infarction; New England; Outpatients; Patient Care; Patients; Performance; Peripheral arterial disease; Pharmacologic Substance; Physicians; Policy Maker; Prevention; Primary Care Physician; Principal Investigator; Public Health; Quality of Care; Randomized; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Reporting; State Medicine; Stroke; System; Testing; Thiazide Diuretics; Time; Translating; Translational Research; Translations; Upper arm; beneficiary; blood pressure regulation; clinical practice; clinically relevant; cost; cost effectiveness; editorial; effective intervention; financial incentive; health care delivery; high reward; hypertension control; hypertension treatment; improved; meetings; neglect; payment; prevent; primary care setting; programs; routine practice

DESCRIPTION (provided by applicant): Despite compelling evidence of the benefits of treatment, hypertension is controlled in less than 1/4th of US citizens. Inadequate blood pressure control results in excess cases of coronary artery disease, congestive heart failure, stroke and other diseases. While some of the reasons for poor blood pressure control are due to poor compliance on the part of patients, there is significant under-treatment of hypertension on the part of physicians. In 1 recent study, people with hypertension received less than 65% of recommended care. Translation of scientific knowledge from trials such as the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial [ALLHAT] into clinical practice and improved health for patients is lagging. Heightened awareness of "bottlenecks" in the translation of research knowledge into clinical practice has raised enthusiasm about using creative methods, including financial incentives, to improve translation. Indeed, pharmaceutical companies have been using financial incentives to change physician behavior for decades. Using a randomized controlled trial, we will test the effect of explicit physician-level financial incentives to promote translation of findings from the ALLHAT trial into clinical practice and improved control of hypertension in the primary care setting. A total of 130 primary care physicians will be randomized to 2 study arms: 1) physician-level financial incentive only + audit and feedback; and 2) audit and feedback only. Use of thiazide diuretics among eligible patients according to the ALLHAT study criteria and the proportion of patients achieving goal blood pressure according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure goal will be the pdmary dependent variables. We will use analytic methods appropriate for a cluster-randomized trial, as patients are nested within physicians, who are further nested in hospitals. We will assess whether financial incentives are a cost-effective intervention. Findings from this study will provide critical information needed to implement methods of "paying for performance" and will be directly applicable to such programs for the 40.5 million Medicare beneficiaries and the more than 18 million individuals cared for in staff-model health care delivery systems.

描述(由申请人提供)：尽管有令人信服的证据表明治疗的好处，但只有不到四分之一的美国公民高血压得到了控制。血压控制不当会导致冠状动脉疾病、充血性心力衰竭、中风等疾病的病例过多。虽然血压控制不佳的一些原因是由于患者的依从性较差，但医生对高血压的治疗严重不足。在最近的一项研究中，高血压患者得到的推荐护理不到65%。将抗高血压和降脂治疗以预防心脏病发作试验[ALLHAT]等试验的科学知识转化为临床实践和改善患者健康的工作滞后。对将研究知识转化为临床实践中的“瓶颈”的认识的提高，提高了使用包括财政激励在内的创造性方法来改进翻译的热情。事实上，几十年来，制药公司一直在利用财务激励来改变医生的行为。使用随机对照试验，我们将测试明确的医生层面的经济激励的效果，以促进ALLHAT试验的结果转化为临床实践，并改善初级保健环境中的高血压控制。总共130名初级保健医生将被随机分成两个研究组：1)仅限于医生级别的经济激励+审计和反馈；以及2)仅限于审计和反馈。根据ALLHAT研究标准在符合条件的患者中使用噻嗪类利尿剂，以及根据全国高血压预防、检测、评估和治疗联合委员会第七次报告达到目标血压的患者比例将是主要的因变量。我们将使用适合于整群随机试验的分析方法，因为患者嵌套在医生内部，而内科医生又进一步嵌套在医院。我们将评估财政激励是否是一种具有成本效益的干预措施。这项研究的结果将提供实施“绩效付费”方法所需的关键信息，并将直接适用于4050万联邦医疗保险受益人和1800多万在工作人员模式的医疗保健提供系统中得到护理的个人的此类计划。