Rw. Kouides et al., PERFORMANCE-BASED PHYSICIAN REIMBURSEMENT AND INFLUENZA IMMUNIZATION RATES IN THE ELDERLY, American journal of preventive medicine, 14(2), 1998, pp. 89-95
Citations number
28
Categorie Soggetti
Medicine, General & Internal","Public, Environmental & Occupation Heath
Objective: To investigate the effect of performance-based financial in
centives on the influenza immunization rate in primary care physicians
' offices. Design: Randomized controlled trial during the 1991 influen
za immunization season. Setting: Rochester, New York, and surrounding
Monroe County during the Medicare Influenza Vaccine Demonstration Proj
ect. Participants: A total of 54 solo or group practices that had part
icipated in the 1990 Medicare Demonstration Project. Interventions: Al
l physicians in participating practices agreed to enumerate their ambu
latory patients aged 65 or older who had been seen during the 1990 or
1991 calendar years, and to track the immunization rate on a weekly ba
sis using a specially designed poster from September 1991 to January 1
, 1992. Additionally, physicians agreed to be randomized, by practice
group, to the control group or to the incentive group, which could rec
eive an additional $.80 per shot or $1.60 per shot if an immunization
rate of 70% or 85%, respectively, was attained. Measurements: The main
outcome measures are the 1991 immunization rate and the improvement i
n immunization rate from the 1990 to 1991 influenza seasons for each g
roup practice. Results: For practices in the incentive group, the mean
immunization rate was 68.6% (SD 16.6%) compared with 62.7% (SD 18.0%)
in the control group practices (P = .22). The median practice-specifi
c improvement in immunization rate was +10.3% in the incentive group c
ompared with +3.5% in the control group (P = .03). Conclusions: Despit
e high background immunization rates, this modest financial incentive
was responsible for similar to 7% increase in immunization rate among
the ambulatory elderly.