Financial Incentives to Translate ALLHAT into Practice

将 ALLHAT 转化为实践的经济激励

基本信息

批准号：
7458181
负责人：
LAURA A PETERSEN
金额：
$ 13.48万
依托单位：
BAYLOR COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2005
资助国家：
美国
起止时间：
2005-09-01 至 2012-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7458181
关键词：
Administrator Adopted Antihypertensive Agents Awareness Behavior Blood Pressure Caring Clinical Clinical Research Clinical Trials Condition Congestive Heart Failure Coronary Arteriosclerosis Cost Control Costs and Benefits Coupled Detection Disease Evaluation Feedback Goals Guidelines Health Health Services Healthcare High Blood Pressure Hospitals Hypertension Incentives Individual Institute of Medicine (U.S.)Intervention Joints Journals Kidney Failure Knowledge LDL Cholesterol Lipoproteins Lead Lipids Measures Medicare Methods Myocardial Infarction New England Outpatients Patient Care Patients Performance Peripheral arterial disease Pharmacologic Substance Physicians Policy Maker Prevention Primary Care Physician Primary Health Care Public Health Quality of Care Randomized Randomized Controlled Clinical Trials Randomized Controlled Trials Reporting Research Research Personnel Rewards State Medicine Stroke System Testing Thiazide Diuretics Time Translating Translations Upper arm beneficiary blood pressure regulation clinically relevant cost cost effectiveness editorial health care delivery health care model hypertension treatment improved neglect payment prevent programs

项目摘要

Despite compelling evidence of the benefits of treatment, hypertension is controlled in less than one-quarter of US citizens. Inadequate blood pressure control results in excess cases of coronary artery disease, congestive heart failure, stroke and other diseases. While some of the reasons for poor blood pressure control are due to poor compliance on the part of patients, there is significant under-treatment of hypertension on the part of physicians. In one recent study, people with hypertension received less than 65% of recommended care. Translation of scientific knowledge from trials such as the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial [ALLHATJ into clinical practice and improved health for patients is lagging. Heightened awareness of =bottlenecks" in the translation of research knowledge into clinical practice has raised enthusiasm about using creative methods, including financial incentives, to improve translation. Indeed, pharmaceutical companies have been using financial incentives to change physician behavior for decades. Using a randomized controlled trial, we will test the effect of explicit physician-level financial incentives to promote translation of findings from the ALLHAT trial into clinical practice and improved control of hypertension in the primary care setting. A total of 130 primary care physicians will be randomized to two study arms: 1) physician-level financial incentive only + audit and feedback; and 2) audit and feedback only. Use of thiazide diuretics among eligible patients according to the ALLHAT study criteria and the proportion of patients achieving goal blood pressure according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure goal will be the pdmary dependent variables. We will use analytic methods appropriate for a cluster-randomized trial, as patients are nested within physicians, who are further nested in hospitals. We will assess whether financial incentives are a cost-effective intervention. Findings from this study will provide critical information needed to implement methods of "paying for performance" and will be directly applicable to such programs for the 40.5 million Medicare beneficiaries and the more than 18 million individuals cared for in staff-model health care delivery systems.

尽管有令人信服的证据表明治疗的益处，但高血压在不到四分之一的时间内得到了控制美国公民。血压控制不足会导致冠状动脉疾病病例增多，充血性心力衰竭、中风等疾病。虽然血压不佳的一些原因由于患者依从性差，治疗不足的情况严重医生的高血压。在最近的一项研究中，高血压患者接受的治疗少于 65% 的建议护理。抗高血压试验等科学知识的翻译和降脂治疗预防心脏病试验[ALLHATJ进入临床实践并改进患者的健康状况滞后。提高对研究翻译中的“瓶颈”的认识将知识融入临床实践激发了人们使用创造性方法的热情，包括财务方法激励措施，以改进翻译。事实上，制药公司一直在使用财务激励措施改变几十年来医生的行为。我们将使用随机对照试验来测试效果明确的医生层面的经济激励措施，以促进将 ALLHAT 试验的结果转化为临床实践和改善初级保健机构高血压的控制。小学一共有130个护理医生将被随机分配到两个研究组：1）仅医生级别的经济激励+审计和反馈; 2) 仅审核和反馈。根据《符合条件的患者使用噻嗪类利尿剂》 ALLHAT 研究标准和达到目标血压的患者比例全国预防、检测、评估和治疗联合委员会第七次报告高血压目标将是主要因变量。我们将使用分析方法适合整群随机试验，因为患者嵌套在医生中，而医生又进一步嵌套在医院。我们将评估财政激励措施是否是一种具有成本效益的干预措施。调查结果来自这项研究将提供实施“按绩效付费”方法所需的关键信息，并将直接适用于 4050 万医疗保险受益人和超过 18 名医疗保险受益人的此类计划数百万人在员工模式的医疗保健服务系统中得到照顾。