Improving the Recording of Diagnoses in Primary Care with Team Incentives: A Controlled Longitudinal Follow-Up Study

Abstract

Introduction We studied whether primary care teams respond to financial group bonuses by improving the recording of diagnoses, whether this intervention leads to diagnoses reflecting the anticipated distribution of diseases, and how the recording of a significant chronic disease, diabetes, alters after the application of these bonuses. Methods We performed an observational register-based retrospective quasi-experimental follow-up study with before-and-after setting and two control groups in primary healthcare of a Finnish town. We studied the rate of recorded diagnoses in visits to general practitioners with interrupted time series analysis. The distribution of these diagnoses was also recorded. Results After group bonuses, the rate of recording diagnoses increased by 17.9% (95% CI: 13.6–22.3) but not in either of the controls (−2.0 to −0.3%). The increase in the rate of recorded diagnoses in the care teams varied between 14.9% (4.7–25.2) and 33.7% (26.6–41.3). The distribution of recorded diagnoses resembled the respective distribution of diagnoses in the former studies of diagnoses made in primary care. The rate of recorded diagnoses of diabetes did not increase just after the intervention. Conclusions In primary care, the completeness of diagnosis recording can be, to varying degrees, influenced by group bonuses without guarantee that recording of clinically significant chronic diseases is improved.

The effect of electronic reminders on the recording of diagnoses in primary care: A quasi-experimental before and after study

“…In primary health care, the recording of diagnoses is needed to ensure treatment actions, planning activities and management of resources. [1][2][3] Financial incentives to individual general practitioners (GPs) 4 or to multidisciplinary care teams 5 are reported to be effective in increasing the recording of diagnoses in primary care.…”

“…In a quite similar neighboring city, Espoo, it had been possible to increase the frequency of recording diagnoses from 55% of all visits to GPs to a level of 90% by using financial group bonuses for primary care teams. 5 Vantaa had no resources for such financial incentives. Since electronic reminders have also been shown to be effective in modifying the work practices of GPs, 6 the administration of Vantaa primary health care installed an electronic reminder into the electronic health record system to improve the recording of diagnoses by the care teams in one of its regions, called Hakunila-Länsimäki.…”

Recording of diagnoses in public primary oral health care in a retrospective longitudinal observational study in a Finnish town: Underrepresentation of periodontitis diagnoses

“…For these reasons, the administration of the primary care of Espoo City considered the recording of diagnoses by both public primary care general practitioners (GPs) and dentists to be insufficient (Kallio, Kauppila, Suominen, & Heikkinen, 2017;Lehtovuori et al, 2018). In primary care, which thus was under the same administration, a financial incentive (group bonus) was used to enhance the recording of diagnoses by GPs (Lehtovuori et al, 2018). These financial incentives were found to be effective in increasing the overall recording of diagnoses from about 40 to 90% (Lehtovuori et al, 2018).…”

“…In primary care, which thus was under the same administration, a financial incentive (group bonus) was used to enhance the recording of diagnoses by GPs (Lehtovuori et al, 2018). These financial incentives were found to be effective in increasing the overall recording of diagnoses from about 40 to 90% (Lehtovuori et al, 2018). By contrast, after paying special attention in 2009 to the recording of diagnoses for visits to public primary oral health care dentists, but without using incentives, the rate rose from 0 to 35% (Kallio et al, 2017).…”

“…Unexpectedly, group bonuses failed to enhance the recording of diagnoses of chronic diseases such as diabetes in the public primary care of Espoo (Lehtovuori et al, 2018). Such chronic diseases are the major cause of oral health problems (Kassebaum et al, 2017).…”