Financial incentives and physician commitment to guideline-recommended hypertension management.

Hysong SJ, Simpson K, Pietz K, SoRelle R, Broussard Smitham K, Petersen LA. Financial incentives and physician commitment to guideline-recommended hypertension management. The American journal of managed care. 2012 Oct 1; 18(10):e378-91.

Related HSR&D Project(s)

• IIR 04-349 – RCT of Financial Incentives to Translate ALLHAT into Practice
• CDA 07-018 – Organizational Correlates of Outpatient Performance Trends in VAMCs

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Abstract:

OBJECTIVES: To examine the impact of financial incentives on physician goal commitment to guideline-recommended hypertension care. STUDY DESIGN: Clinic-level cluster-randomized trial with 4 arms: individual, group, or combined incentives, and control. METHODS: A total of 83 full-time primary care physicians at 12 Veterans Affairs medical centers completed web-based surveys measuring their goal commitment to guideline-recommended hypertension care every 4 months and telephone interviews at months 8 and 16. Intervention arm participants received performance-based incentives every 4 months for 5 periods. All participants received guideline education at baseline and audit and feedback every 4 months. RESULTS: Physician goal commitment did not vary over time or across arms. Participants reported patient nonadherence was a perceived barrier and consistent follow-up was a perceived facilitator to successful hypertension care, suggesting that providers may perceive hypertension management as more of a patient responsibility (external locus of control). CONCLUSIONS: Financial incentives may constitute an insufficiently strong intervention to influence goal commitment when providers attribute performance to external forces beyond their control.