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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1031 — Do Financial Incentives for Guideline Adherence Improve HTN Care for African-American Patients? A Multi-Site RCT

Simpson KLWoodard LPietz KC, and Petersen LA, HSR&D Center of Excellence, Houston VAMC; and Baylor College of Medicine;

Few data exist regarding the effectiveness of pay-for-performance (P4P) programs in healthcare, and there is concern that these programs could have unintended consequences on minority patients. We evaluated the effect of P4P on the quality of hypertension care provided to black patients using a multi-site cluster randomized controlled trial.

Each of the 12 participating VA hospitals were randomized to one of four arms: 1) physician-level incentives; 2) practice group-level incentives; 3) combined physician- and group-level incentives; or 4) control. Primary care physicians participated in all arms. Non-physician staff also participated in the group arms. Participants received an educational session about hypertension management. At the end of each of five four-month performance periods, all participants received audit and feedback on the proportion of the physicians’ patients receiving guideline-recommended antihypertensive medications and the proportion with controlled blood pressure (BP) or who received an appropriate clinical response to an elevated BP. Intervention arm participants received monetary rewards commensurate with performance (average total payment for an individual arm physician = $2,672). We collected data on black patients from 67 participating physicians.

Black patients had lower rates of BP control at baseline. In a linear regression model controlling for physicians’ baseline performance, race, whether the physician worked at a teaching hospital, and geographic region, the proportion of black patients who either achieved BP control or received an appropriate response to uncontrolled BP in the final performance period was 6.3% greater for physicians in an incentive arm than for physicians in the control arm (p = 0.025). In other words, for two study physicians with similar baseline characteristics and panel sizes of 1,000 patients, the physician in the intervention arm would have 63 more black patients achieving BP control or receiving an appropriate response per year due to the intervention.

A P4P intervention for physicians and healthcare groups significantly improved levels of BP control or appropriate response to uncontrolled BP within black hypertensive patients.

If properly designed, performance-based healthcare payment models could improve the quality of care for black patients. Further studies are needed to determine the effect of P4P programs on health disparities.

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