Trial Outcomes & Findings for Financial Incentives to Translate ALLHAT Into Practice: A Randomized Trial (NCT NCT00302718)
NCT ID: NCT00302718
Last Updated: 2019-01-30
Results Overview
This measure reports the unadjusted proportion of physicians' patients meeting the study outcome for the first performance period (baseline). Data are based on review of the electronic health records for 40 patients with hypertension randomly selected from each physician's panel. We used the guidelines from the "Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)" to determine if the physicians' patients achieved the recommended blood pressures thresholds and if providers appropriately responded to uncontrolled blood pressure. Appropriate responses included increasing the dosage of a guideline-recommended antihypertensive medication or recommending a lifestyle modification to patient with Stage 1 hypertension.
COMPLETED
NA
83 participants
Baseline period (August-November 2007)
2019-01-30
Participant Flow
We enrolled non-physician primary care personnel at the hospitals randomized to the two study arms that tested the effect of practice-level incentives. Only data from physicians were used to assess both physician-level and practice-level performances. This participant enrollment table does not include data on the non-physician participants.
Participant milestones
| Measure |
Physician-level Incentives
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Overall Study
STARTED
|
20
|
21
|
21
|
21
|
|
Overall Study
COMPLETED
|
19
|
20
|
19
|
19
|
|
Overall Study
NOT COMPLETED
|
1
|
1
|
2
|
2
|
Reasons for withdrawal
| Measure |
Physician-level Incentives
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Overall Study
Participant left the hospital
|
1
|
0
|
0
|
1
|
|
Overall Study
Withdrawal by Subject
|
0
|
1
|
0
|
0
|
|
Overall Study
Participant left primary care setting
|
0
|
0
|
2
|
1
|
Baseline Characteristics
Financial Incentives to Translate ALLHAT Into Practice: A Randomized Trial
Baseline characteristics by cohort
| Measure |
Physician-level Incentives
n=19 Participants
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=20 Participants
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=19 Participants
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=19 Participants
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
Total
n=77 Participants
Total of all reporting groups
|
|---|---|---|---|---|---|
|
Age, Continuous
|
45 years
STANDARD_DEVIATION 8 • n=5 Participants
|
48 years
STANDARD_DEVIATION 8 • n=7 Participants
|
44 years
STANDARD_DEVIATION 6 • n=5 Participants
|
48 years
STANDARD_DEVIATION 7 • n=4 Participants
|
46 years
STANDARD_DEVIATION 8 • n=21 Participants
|
|
Sex: Female, Male
Female
|
11 Participants
n=5 Participants
|
8 Participants
n=7 Participants
|
9 Participants
n=5 Participants
|
6 Participants
n=4 Participants
|
34 Participants
n=21 Participants
|
|
Sex: Female, Male
Male
|
8 Participants
n=5 Participants
|
12 Participants
n=7 Participants
|
10 Participants
n=5 Participants
|
13 Participants
n=4 Participants
|
43 Participants
n=21 Participants
|
|
Race/Ethnicity, Customized
White
|
7 participants
n=5 Participants
|
7 participants
n=7 Participants
|
9 participants
n=5 Participants
|
8 participants
n=4 Participants
|
31 participants
n=21 Participants
|
|
Race/Ethnicity, Customized
Black
|
3 participants
n=5 Participants
|
2 participants
n=7 Participants
|
1 participants
n=5 Participants
|
0 participants
n=4 Participants
|
6 participants
n=21 Participants
|
|
Race/Ethnicity, Customized
Asian Indian
|
5 participants
n=5 Participants
|
5 participants
n=7 Participants
|
6 participants
n=5 Participants
|
5 participants
n=4 Participants
|
21 participants
n=21 Participants
|
|
Race/Ethnicity, Customized
Other
|
4 participants
n=5 Participants
|
6 participants
n=7 Participants
|
3 participants
n=5 Participants
|
6 participants
n=4 Participants
|
19 participants
n=21 Participants
|
|
Region of Enrollment
United States
|
19 participants
n=5 Participants
|
20 participants
n=7 Participants
|
19 participants
n=5 Participants
|
19 participants
n=4 Participants
|
77 participants
n=21 Participants
|
PRIMARY outcome
Timeframe: Baseline period (August-November 2007)Population: The number of physicians listed is those who participated in the baseline period. The participant flow diagram describes the final number of physicians who received at least two instances of the intervention and were included in the repeated-measures longitudinal analysis.
This measure reports the unadjusted proportion of physicians' patients meeting the study outcome for the first performance period (baseline). Data are based on review of the electronic health records for 40 patients with hypertension randomly selected from each physician's panel. We used the guidelines from the "Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)" to determine if the physicians' patients achieved the recommended blood pressures thresholds and if providers appropriately responded to uncontrolled blood pressure. Appropriate responses included increasing the dosage of a guideline-recommended antihypertensive medication or recommending a lifestyle modification to patient with Stage 1 hypertension.
Outcome measures
| Measure |
Physician-level Incentives
n=760 Patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=720 Patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=680 Patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=720 Patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Proportion of the Physicians' Patients With Blood Pressure Control or Appropriate Response to Uncontrolled Blood Pressure
|
75 percentage of physicians' patients
|
80 percentage of physicians' patients
|
79 percentage of physicians' patients
|
86 percentage of physicians' patients
|
PRIMARY outcome
Timeframe: Final intervention period (April-July 2009)Population: The number of physicians listed is those who participated in the final intervention period. The participant flow diagram describes the final number of physicians who received at least two instances of the intervention and were included in the repeated-measures longitudinal analysis.
This measure reports the unadjusted proportion of physicians' patients meeting the study outcome for the fifth and final intervention performance period. Data are based on review of the electronic health records for 40 patients with hypertension randomly selected from each physician's panel. We used the guidelines from the "Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)" to determine if the physicians' patients achieved the recommended blood pressures thresholds and if providers appropriately responded to uncontrolled blood pressure. Appropriate responses included increasing the dosage of a guideline-recommended antihypertensive medication or recommending a lifestyle modification to patient with Stage 1 hypertension.
Outcome measures
| Measure |
Physician-level Incentives
n=720 Patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=760 Patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=600 Patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=760 Patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Proportion of Physicians' Patients With Blood Pressure Control or Appropriate Response to Uncontrolled Blood Pressure
|
84 percentage of physicians' patients
|
85 percentage of physicians' patients
|
88 percentage of physicians' patients
|
86 percentage of physicians' patients
|
PRIMARY outcome
Timeframe: After the washout period (May-August 2011)Population: The number of physicians listed is those who participated in the post-washout performance period. The participant flow diagram describes the final number of physicians who received at least two instances of the intervention and were included in the repeated-measures longitudinal analysis.
This measure reports the unadjusted proportion of physicians' patients meeting the study outcome for the post-washout performance period. Data are based on review of the electronic health records for 40 patients with hypertension randomly selected from each physician's panel. We used the guidelines from the "Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)" to determine if the physicians' patients achieved the recommended blood pressures thresholds and if providers appropriately responded to uncontrolled blood pressure. Appropriate responses included increasing the dosage of a guideline-recommended antihypertensive medication or recommending a lifestyle modification to patient with Stage 1 hypertension.
Outcome measures
| Measure |
Physician-level Incentives
n=520 Patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=680 Patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=440 Patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=560 Patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Proportion of Physicians' Patients With Blood Pressure Control or Appropriate Response to Uncontrolled Blood Pressure
|
83 percentage of physicians' patients
|
82 percentage of physicians' patients
|
83 percentage of physicians' patients
|
87 percentage of physicians' patients
|
PRIMARY outcome
Timeframe: Baseline period (August-November 2007)Population: The number of physicians listed is those who participated in the baseline period. The participant flow diagram describes the final number of physicians who received at least two instances of the intervention and were included in the repeated-measures longitudinal analysis.
This measure reports the unadjusted proportion of physicians' patients meeting the study outcome for the first performance period (baseline). Data are based on review of the electronic health records for 40 patients with hypertension randomly selected from each physician's panel. We used the "Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)" to evaluate use of guideline-recommended antihypertensive medications. Assessing use of guideline-recommended medications included collecting information about the patient's compelling conditions (e.g., diabetes mellitus) as well as allergies and refusals to antihypertensive medications.
Outcome measures
| Measure |
Physician-level Incentives
n=760 Patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=720 Patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=680 Patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=720 Patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Proportion of Physicians' Patients Prescribed Guideline-recommended Antihypertensive Medications
|
61 percentage of physicians' patients
|
56 percentage of physicians' patients
|
65 percentage of physicians' patients
|
63 percentage of physicians' patients
|
PRIMARY outcome
Timeframe: Final intervention period (April-July 2009)Population: The number of physicians listed is those who participated in the final intervention performance period. The participant flow diagram describes the final number of physicians who received at least two instances of the intervention and were included in the repeated-measures longitudinal analysis.
This measure reports the unadjusted proportion of physicians' patients meeting the study outcome for the fifth and final intervention performance period. Data are based on review of the electronic health records for 40 patients with hypertension randomly selected from each physician's panel. We used the "Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)" to evaluate use of guideline-recommended antihypertensive medications. Assessing use of guideline-recommended medications included collecting information about the patient's compelling conditions (e.g., diabetes mellitus) as well as allergies and refusals to antihypertensive medications.
Outcome measures
| Measure |
Physician-level Incentives
n=720 Patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=760 Patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=600 Patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=760 Patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Proportion of Physicians' Patients Prescribed Guideline-recommended Antihypertensive Medications
|
73 percentage of physicians' patients
|
65 percentage of physicians' patients
|
80 percentage of physicians' patients
|
72 percentage of physicians' patients
|
PRIMARY outcome
Timeframe: After the washout period (May-August 2011)Population: The number of physicians listed is those who participated in the post-washout performance period. The participant flow diagram describes the final number of physicians who received at least two instances of the intervention and were included in the repeated-measures longitudinal analysis.
This measure reports the unadjusted proportion of physicians' patients meeting the study outcome for the post-washout performance period. Data are based on review of the electronic health records for 40 patients with hypertension randomly selected from each physician's panel. We used the "Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)" to evaluate use of guideline-recommended antihypertensive medications. Assessing use of guideline-recommended medications included collecting information about the patient's compelling conditions (e.g., diabetes mellitus) as well as allergies and refusals to antihypertensive medications.
Outcome measures
| Measure |
Physician-level Incentives
n=520 Patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=680 Patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=440 Patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=560 Patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Proportion of Physicians' Patients Prescribed Guideline-recommended Antihypertensive Medications
|
66 percentage of physicians' patients
|
65 percentage of physicians' patients
|
73 percentage of physicians' patients
|
71 percentage of physicians' patients
|
SECONDARY outcome
Timeframe: Baseline period (August - November 2007)Population: All patients aged 51-74 at the time of qualifying visit with no history of CRC. We used data from chart reviews to evaluate this measure.
This measure reports the proportion of patients who had at least one of four CRC screens in the appropriate timeframe for the first performance period (baseline). Appropriate CRC screens consisted of at least one of the following: 1) fecal occult blood test every year; 2) barium enema every five years; 3) flexible sigmoidoscopy every five years; 4) colonoscopy every ten years. We did not measure the pre-specified post washout period results for this secondary outcome. The pre-specified post washout period results were not to be measured if the final intervention period results were not significant.
Outcome measures
| Measure |
Physician-level Incentives
n=440 patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=444 patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=463 patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=343 patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Colorectal Cancer (CRC) Screening
|
80.68 percentage of physicians' patients
|
80.18 percentage of physicians' patients
|
79.05 percentage of physicians' patients
|
80.47 percentage of physicians' patients
|
SECONDARY outcome
Timeframe: Final intervention period (April-July 2009)Population: All patients aged 51-74 at the time of qualifying visit with no history of CRC. We used data from chart reviews to evaluate this measure.
This measure reports the proportion of patients who had at least one of four CRC screens in the appropriate timeframe for the fifth and final intervention performance period. Appropriate CRC screens consisted of at least one of the following: 1) fecal occult blood test every year; 2) barium enema every five years; 3) flexible sigmoidoscopy every five years; 4) colonoscopy every ten years. We did not measure the pre-specified post washout period results for this secondary outcome. The pre-specified post washout period results were not to be measured if the final intervention period results were not significant.
Outcome measures
| Measure |
Physician-level Incentives
n=460 patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=450 patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=487 patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=370 patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Colorectal Cancer (CRC) Screening
|
80.43 percentage of physicians' patients
|
80.22 percentage of physicians' patients
|
72.28 percentage of physicians' patients
|
85.41 percentage of physicians' patients
|
SECONDARY outcome
Timeframe: Baseline period (August-November 2007)Population: All patients at high risk for elevated LDL. These patients have any of the following: 1) a history of ischemic heart disease, angioplasty, or coronary artery bypass grafting; 2) a history or diagnosis of peripheral artery disease or aortic aneurism; 3) a compelling indication of diabetes. We used data from chart reviews to evaluate this measure.
This measure reports the proportion of patients who had LDL control (LDL cholesterol \< 100) for the first performance period (baseline). We did not measure the pre-specified post washout period results for this secondary outcome. The pre-specified post washout period results were not to be measured if the final intervention period results were not significant.
Outcome measures
| Measure |
Physician-level Incentives
n=374 patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=355 patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=365 patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=326 patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Low-density Lipoprotein (LDL) Cholesterol Levels
|
64.17 percentage of physicians' patients
|
66.76 percentage of physicians' patients
|
66.58 percentage of physicians' patients
|
68.10 percentage of physicians' patients
|
SECONDARY outcome
Timeframe: Final intervention period (April-July 2009)Population: All patients at high risk for elevated LDL. These patients have any of the following: 1) a history of ischemic heart disease, angioplasty, or coronary artery bypass grafting; 2) a history or diagnosis of peripheral artery disease or aortic aneurism; 3) a compelling indication of diabetes. We used data from chart reviews to evaluate this measure.
This measure reports the proportion of patients who had LDL control (LDL cholesterol \< 100) for the fifth and final intervention performance period. We did not measure the pre-specified post washout period results for this secondary outcome. The pre-specified post washout period results were not to be measured if the final intervention period results were not significant.
Outcome measures
| Measure |
Physician-level Incentives
n=413 patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=351 patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=381 patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=340 patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Low-density Lipoprotein (LDL) Cholesterol Levels
|
75.30 percentage of physicians' patients
|
70.37 percentage of physicians' patients
|
69.55 percentage of physicians' patients
|
74.12 percentage of physicians' patients
|
SECONDARY outcome
Timeframe: Baseline period (August-November 2007)Population: All patients with a compelling indication of diabetes, including a history of diagnosis of diabetes, was taking diabetes medications at index visit, or has a fasting blood sugar level ≥ 126 or random blood sugar ≥ 200. We used data from chart reviews to evaluate this measure.
This measure reports the proportion of patients with (Hb)A1c control ((Hb)A1c ≤ 9%) for the first performance period (baseline). We did not measure the pre-specified post washout period results for this secondary outcome. The pre-specified post washout period results were not to be measured if the final intervention period results were not significant.
Outcome measures
| Measure |
Physician-level Incentives
n=238 patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=271 patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=270 patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=217 patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Hemoglobin (Hb) A1c Levels
|
92.02 percentage of physicians' patients
|
90.04 percentage of physicians' patients
|
89.63 percentage of physicians' patients
|
91.24 percentage of physicians' patients
|
SECONDARY outcome
Timeframe: Final intervention period (April-July 2009)Population: All patients with a compelling indication of diabetes, including a history of diagnosis of diabetes, was taking diabetes medications at index visit, or has a fasting blood sugar level ≥ 126 or random blood sugar ≥ 200. We used data from chart reviews to evaluate this measure.
This measure reports the proportion of patients with (Hb)A1c control ((Hb)A1c ≤ 9%) for the fifth and final intervention performance period. We did not measure the pre-specified post washout period results for this secondary outcome. The pre-specified post washout period results were not to be measured if the final intervention period results were not significant.
Outcome measures
| Measure |
Physician-level Incentives
n=283 patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=243 patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=265 patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=235 patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Hemoglobin (Hb) A1c Levels
|
89.05 percentage of physicians' patients
|
91.77 percentage of physicians' patients
|
90.94 percentage of physicians' patients
|
91.49 percentage of physicians' patients
|
SECONDARY outcome
Timeframe: Baseline period (August - November 2007)Population: All patients with at least one of the following: 1) a history of diagnosis of ischemic heart disease (IHD), angioplasty, or CABG; 2) a history of myocardial infarction (MI); 3) patients who have a history of USA. We used data from chart reviews to evaluate this measure.
This measure reports the proportion of patients with beta blocker use at the time of the index visit for the first performance period (baseline). We did not measure the pre-specified post washout period results for this secondary outcome. The pre-specified post washout period results were not to be measured if the final intervention period results were not significant.
Outcome measures
| Measure |
Physician-level Incentives
n=203 patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=135 patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=173 patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=165 patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Beta Blocker Use
|
60.10 percentage of physicians' patients
|
65.93 percentage of physicians' patients
|
64.16 percentage of physicians' patients
|
64.24 percentage of physicians' patients
|
SECONDARY outcome
Timeframe: Final intervention period (April-July 2009)Population: All patients with at least one of the following: 1) a history of diagnosis of ischemic heart disease (IHD), angioplasty, or CABG; 2) a history of myocardial infarction (MI); 3) patients who have a history of USA. We used data from chart reviews to evaluate this measure.
This measure reports the proportion of patients with beta blocker use at the time of the index visit for the fifth and final intervention performance period. We did not measure the pre-specified post washout period results for this secondary outcome. The pre-specified post washout period results were not to be measured if the final intervention period results were not significant
Outcome measures
| Measure |
Physician-level Incentives
n=217 patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=207 patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=200 patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=164 patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Beta Blocker Use
|
70.51 percentage of physicians' patients
|
71.01 percentage of physicians' patients
|
69.50 percentage of physicians' patients
|
70.12 percentage of physicians' patients
|
POST_HOC outcome
Timeframe: Intervention period (February-May 2009)Population: All patients with hypertension from the physicians' panel who had an outpatient encounter between February and May 2009. We used data from automated processing of structured fields from electronic health records to evaluate this measure.
Patients had at least one primary care encounter during the interval assessed. We looked four months from the encounter for evidence of hypotension, either an outpatient systolic blood pressure (BP) \< 90 mm Hg, an outpatient diagnosis of hypotension, or both.
Outcome measures
| Measure |
Physician-level Incentives
n=3792 patient records
Examines the effect of physician-level financial incentives on hypertension quality of care
Physician-level financial incentives: Enrolled physician participants were eligible to receive financial incentives based on their performance during a 4-month interval on the hypertension care study outcomes.
|
Practice-level Incentives
n=4677 patient records
Examines the effect of practice-level financial incentives on hypertension quality of care
Practice-level financial incentives: Enrolled practices (physician participants and non-physician primary care personnel) were eligible to receive financial incentives based on the performance of the practice during a 4-month interval on the hypertension care study outcomes.
|
Physician- and Practice-level Incentives
n=4712 patient records
Examines the effect of physician and practice-level financial incentives on hypertension quality of care
Physician- and practice-level financial incentives: Enrolled subjects were eligible to receive financial incentives based on performance during a 4-month interval on the hypertension care study outcomes. This arm tested the effect of combined financial incentives.
|
No Incentives (Control)
n=4821 patient records
Physician participants in the control group did not receive any financial incentives. They received audit and feedback performance reports at the end of each performance period like the intervention groups.
|
|---|---|---|---|---|
|
Incidence of Hypotension Among All Patients With Hypertension
|
1.4 percentage of all hypertensive patients
|
1.20 percentage of all hypertensive patients
|
1.15 percentage of all hypertensive patients
|
1.12 percentage of all hypertensive patients
|
Adverse Events
Physician-level Incentives
Practice-level Incentives
Physician- and Practice-level Incentives
No Incentives (Control)
Serious adverse events
Adverse event data not reported
Other adverse events
Adverse event data not reported
Additional Information
Dr. Laura A. Petersen
VA HSR&D Center for Innovations in Quality, Effectiveness & Safety (IQuESt)
Results disclosure agreements
- Principal investigator is a sponsor employee
- Publication restrictions are in place