Financial Incentives to Translate ALLHAT into Practice

描述（由申请人提供）：尽管有令人信服的证据表明治疗的益处，但高血压在不到1/4的美国公民中得到控制。血压控制不足导致冠状动脉疾病、充血性心力衰竭、中风和其他疾病的病例过多。虽然血压控制不佳的一些原因是由于患者依从性差，但医生对高血压的治疗严重不足。在最近的一项研究中，高血压患者接受的推荐治疗不到65%。从抗高血压和降脂治疗预防心脏病发作试验[ALLHAT]等试验中获得的科学知识转化为临床实践和改善患者健康的工作正在滞后。人们对将研究知识转化为临床实践的“瓶颈”的认识提高了人们对使用创造性方法（包括经济激励）来改善翻译的热情。事实上，几十年来，制药公司一直在利用经济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水平的经济激励措施的效果，以促进从ALLHAT试验的结果转化为临床实践，并改善控制高血压在初级保健环境。共有130名初级保健医生将被随机分配至2个研究组：1）仅医生级经济激励+稽查和反馈; 2）仅稽查和反馈。根据ALLHAT研究标准，合格患者中噻嗪类利尿剂的使用情况以及根据国家高血压预防、检测、评价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作为主要因变量。我们将使用适合于群集随机试验的分析方法，因为患者嵌套在医生中，医生进一步嵌套在医院中。我们将评估财政激励措施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“按绩效付费”方法所需的关键信息，并将直接适用于4050万医疗保险受益人和1800多万在工作人员模式医疗保健提供系统中接受护理的个人的此类计划。

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.