Long-Term Effects of Financial Incentives for General Practitioners on Quality Indicators in the Treatment of Patients With Diabetes Mellitus in Primary Care—A Follow-Up Analysis of a Cluster Randomized Parallel Controlled Trial
Meier R, Chmiel C, Valeri F, Muheim L, Senn O, Rosemann T
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Background:
The effect of financial incentives on the quality of primary care is of high interest, and so is its sustainability after financial incentives are withdrawn. Objective: To assess both long-term effects and sustainability of financial incentives for general practitioners (GPs) in the treatment of patients with diabetes mellitus based on quality indicators (QIs) calculated from routine data from electronic medical records. Design/Participants: Randomized controlled trial using routine data from electronic medical records of patients with diabetes mellitus of Swiss GPs..
Methods:
Intervention: During the study period of 24 months, all GPs received bimonthly feedback reports with information on their actual treatment as reflected in QIs. In the intervention group, the reports were combined with financial incentives for quality improvement. The incentive was stopped after 12 months. Measurements: Proportion of patients meeting the process QI of annual HbA1c measurements and the clinical QI of blood pressure levels below 140/85 mmHg.
Results:
Insgesamt wurden 71 Hausärzt*innen aus 43 verschiedenen Praxen und folglich 3'854 ihrer Patient*innen mit Diabetes mellitus eingeschlossen. Während der Studie blieb der Anteil der Patient*innen mit jährlichen HbA1c-Messungen in der Interventionsgruppe stabil (78.8–78.9%) und verminderte sich leicht in der Kontrollgruppe (81.5–80.2%) [OR: 1.21, 95%-CI: 1.04–1.42, p < 0.05]. Der Anteil von Patient*innen mit einem Blutdruckwert unter 140/85 mmHg verminderte sich in der Kontrollgruppe (51.2–47.2%) und erhöhte sich in der Interventionsgruppe (49.7–51.9%) [OR: 1.18, 95%-CI: 1.04–1.32, p < 0.05], wo es nach 18 Monaten mit 54.9% seinen Höchstwert erreichte und in den letzten 6 Monaten wieder stetig abnahm.
Conclusion:
After the withdrawal of financial incentives for the GPs after 12 months, some QIs still improved, indicating that 1 year might be too short to observe the full effect of such interventions. The decrease in QI achievement rates after 18 months suggests that the positive effects of time-limited financial incentives eventually wane.