Rw. Kouides et al., A PERFORMANCE-BASED INCENTIVE PROGRAM FOR INFLUENZA IMMUNIZATION IN THE ELDERLY, American journal of preventive medicine, 9(4), 1993, pp. 250-255
Our objective was to implement and evaluate performance-based reimburs
ement for influenza immunization of the elderly in physician offices.
We performed a community-based quasi-experiment with historic and conc
urrent comparisons, using primary care physician offices in Monroe Cou
nty, New York. Participants in the intervention group included 53 prim
ary care physicians admitting to one hospital, and the comparison grou
p included 82 primary care physicians admitting to other hospitals. Al
l physicians participated in a Medicare-sponsored demonstration to inc
rease influenza immunization rates, and, during the 1990-1991 immuniza
tion season, used a target-based poster to track immunization rates. P
hysicians in the intervention group were enrolled in a performance-bas
ed financial incentive program that rewarded immunization rates above
70%. A survey concerning influenza immunization practices and opinions
was sent to all physicians. The average physician-specific immunizati
on rate in the incentive group was 73.1% versus 55.7% in the compariso
n practices (P < .001). Eligibility for incentives, practice size, sex
of physician, medical specialty, reminder postcards, and practice pop
ulations including medically indigent patients were associated with im
munization level. Controlling for the above variables, we completed a
regression analysis showing that eligibility for the incentive was sti
ll significant (P = .003). The survey responses were not predictive of
performance or significantly different between the two groups, except
for the negative influence of sending postcards. This study in a comm
unity setting suggests that linking reimbursement to performance may b
e a successful strategy to increase influenza immunization levels for
the elderly.