Financial Incentives to Translate ALLHAT into Practice

将 ALLHAT 转化为实践的经济激励

• 批准号: 7845807
• 负责人: LAURA A PETERSEN
• 金额: $ 26.78万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2011-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7845807
• 关键词: Administrator; Adopted; Antihypertensive Agents; Awareness; Behavior; Blood Pressure; Caring; Clinical Research; Clinical Trials; Congestive Heart Failure; Coronary Arteriosclerosis; Cost Control; Costs and Benefits; Coupled; Detection; Disease; Evaluation; Feedback; Goals; Guidelines; Health; Health Services; Healthcare; Hospitals; Hypertension; Incentives; Individual; Institute of Medicine (U.S.); Intervention; Joints; Journals; Kidney Failure; Knowledge; LDL Cholesterol Lipoproteins; Lead; Lipids; Measures; Medicare; Methods; Modeling; Myocardial Infarction; New England; Outpatients; Patient Care; Patients; Performance; Peripheral arterial disease; Pharmacologic Substance; Physicians; Policy Maker; Prevention; Primary Care Physician; Principal Investigator; Public Health; Quality of Care; Randomized; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Reporting; State Medicine; Stroke; System; Testing; Thiazide Diuretics; Time; Translating; Translational Research; Translations; Upper arm; beneficiary; blood pressure regulation; clinical practice; clinically relevant; cost; cost effectiveness; editorial; effective intervention; financial incentive; health care delivery; high reward; hypertension control; hypertension treatment; improved; meetings; neglect; payment; prevent; primary care setting; programs; routine practice

DESCRIPTION (provided by applicant): Despite compelling evidence of the benefits of treatment, hypertension is controlled in less than 1/4th 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 1 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 [ALLHAT] 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 2 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.

描述（由申请人提供）：尽管有令人信服的治疗益处的证据，但在美国公民中不到1/4的情况下，高血压受到控制。血压控制不足会导致过量的冠状动脉疾病，充血性心力衰竭，中风和其他疾病。尽管血压控制不力的某些原因是由于患者的依从性不佳，但医生的高血压严重不足。在最近的1项研究中，高血压患者接受了推荐护理的65％。从抗高血压和脂质降低治疗等试验中将科学知识转化为防止心脏病发作试验[allhat]为临床实践，并改善了患者的健康状况。在将研究知识转化为临床实践中，人们对“瓶颈”的认识提高了人们对使用创新方法（包括经济激励措施）来改善翻译的热情。实际上，制药公司数十年来一直使用经济激励措施来改变医师行为。使用随机对照试验，我们将测试明确的医师级财务激励措施的效果，以促进Allhat试验的发现转化为临床实践，并改善初级保健环境中高血压的控制。共有130名初级保健医生将被随机分为2个研究臂：1）医师级的经济激励措施仅 +审计和反馈； 2）仅审核和反馈。根据Allhat研究标准以及根据预防，预防，检测，评估和高血压目标治疗联合委员会的第七次报告，在符合条件的患者中使用噻嗪类利尿剂的比例将是PDMary依赖变量。我们将使用适用于聚类随机试验的分析方法，因为患者嵌套在医院中的医生中，这些方法进一步嵌套在医院中。我们将评估经济激励措施是否是一种经济有效的干预措施。这项研究的结果将提供实施“付款付款”方法所需的关键信息，并将直接适用于4050万Medicare受益人的此类计划以及在员工模型医疗保健提供系统中受到关注的超过1800万个人。