Financial team incentives improved recording of diagnoses in primary care: a quasi-experimental longitudinal follow-up study with controls

Abstract

BackgroundIn primary care, financial incentives have usually been directed to physicians because they are thought to make the key decisions in order to change the functions of a medical organization. There are no studies regarding the impact that directing these incentives to all disciplines of the care team (e.g. group bonuses for both nurses and doctors) may have, despite the low frequency with which diagnoses were being recorded for primary care visits to doctors. This study tested the effect of offering group bonuses to the care teams.MethodsThis was a retrospective quasi-experimental study with before-and-after settings and two control groups. In the intervention group, the mean percentage of visits to a doctor for which a diagnosis was recorded by each individual care team (mean team-based percentage of monthly visits to a doctor with recorded diagnoses) and simultaneously the same data was gathered from two different primary care settings where no team bonuses were applied. To study the sustainability of changes obtained with the group bonuses the respective data were derived from the electronic health record system for 2 years after the cessation of the intervention. The differences in the rate of marking diagnoses was analyzed with ANOVA and RM-ANOVA with appropriate post hoc tests, and the differences in the rate of change in marking diagnoses was analyzed with linear regression followed by t-test.ResultsThe proportion of doctor visits having recorded diagnoses in the teams was about 55 % before starting to use group bonuses and 90 % after this intervention. There was no such increase in control units. The effect of the intervention weakened slightly after cessation of the group bonuses.ConclusionGroup bonuses may provide a method to alter clinical practices in primary care. However, sustainability of these interventions may diminish after ceasing this type of financial incentive.

A Competition between Care Teams Improved Recording of Diagnoses in Primary Dental Care: A Longitudinal Follow-Up Study

“…The rate of change in diagnosis marking in Espoo primary care was analyzed with a regression analysis followed by t -test (GLM procedure of SigmaPlot 10.0 Statistical Software, Systat Software Inc., Richmond, CA, USA) and these rates were compared with t -test [ 4 ]. The monthly frequencies of marking the diagnoses were analyzed by calculating monthly percentages of visits with recorded diagnoses during each of the follow-up years and comparing them with each other.…”

“…The statistical significance was tested with One-Way Repeated-Measures Analysis of Variance followed by Bonferroni correction for multiple comparisons. p < 0.05 was considered to be statistically significant [ 4 ].…”

“…In primary care, the recording of diagnoses is important for ensuring sufficient treatment actions and for planning activities and for managing the resources of primary care [ 1 – 4 ]. Recording of diagnoses makes it possible to document the types and frequency of conditions the dentists encounter, enhance communication with patients and clinicians, enable outcomes-tracking, and facilitate data sharing and different kinds of research [ 5 ].…”

“…In the primary dental care of Espoo, the basic level of the frequency of recording oral disease diagnoses was practically 0% [ 4 ]. A higher frequency of recorded diagnoses was deemed necessary for planning activities and for managing the resources of primary care.…”

“…A higher frequency of recorded diagnoses was deemed necessary for planning activities and for managing the resources of primary care. In primary care of Espoo, it was possible to increase the frequency of recording diagnoses from 55% of all visits to general practitioners to a level of 90% by using financial group bonuses for care teams [ 4 ]. The primary dental care had no resources for financial incentives.…”