Financial Incentives to Translate ALLHAT into Practice

尽管有令人信服的证据表明治疗的好处，但高血压的控制率不到四分之一。 美国公民。血压控制不当会导致冠状动脉疾病的病例过多， 充血性心力衰竭、中风等疾病。虽然血压不佳的一些原因 控制是由于患者的部分依从性差，存在明显的治疗不足 医生方面的高血压。在最近的一项研究中，高血压患者的摄入量低于 65%的推荐护理。将抗高血压药物等试验中的科学知识转化为 和降脂治疗预防心脏病发作试验[ALLHATJ进入临床实践和改进 患者的健康状况正在滞后。提高科研翻译中的瓶颈意识 对临床实践的了解提高了人们对使用创造性方法的热情，包括财务 激励措施，以提高翻译水平。事实上，制药公司一直在使用财务激励措施 几十年来改变医生的行为。使用随机对照试验，我们将测试 明确的医生级财政激励措施，以促进将ALLHAT试验的结果转化为 初级保健环境中高血压的临床实践和改进控制。共有130所小学 护理医生将被随机分成两个研究小组：1)仅医生级别的经济激励+审计和 反馈；以及2)仅审计和反馈。在符合条件的患者中使用噻嗪类利尿剂 ALLHAT研究标准和患者达到目标血压的比例 预防、检测、评估和治疗疟疾国家联合委员会第七次报告 高血压目标将是主要的因变量。我们将使用分析方法 适用于整群随机试验，因为患者嵌套在医生内部，而医生又进一步嵌套 在医院里。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。调查结果来自 这项研究将提供实施“绩效付费”方法所需的关键信息，并将 直接适用于4050万医疗保险受益人及18岁以上人群的此类计划 在工作人员模式的医疗保健提供系统中，有数百万人得到护理。

Despite compelling evidence of the benefits of treatment, hypertension is controlled in less than one-quarter 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 one 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 [ALLHATJ 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 two 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.