Impact of financial incentives on documented immunization rates in the inner city: Results of a randomized controlled trial

Citation
G. Fairbrother et al., Impact of financial incentives on documented immunization rates in the inner city: Results of a randomized controlled trial, AMBU PEDIAT, 1(4), 2001, pp. 206-212
Citations number
22
Categorie Soggetti
Pediatrics
Journal title
AMBULATORY PEDIATRICS
ISSN journal
15301567 → ACNP
Volume
1
Issue
4
Year of publication
2001
Pages
206 - 212
Database
ISI
SICI code
1530-1567(200107/08)1:4<206:IOFIOD>2.0.ZU;2-6
Abstract
Objective.-This study determined the effect of 2 financial incentives-bonus and enhanced fee-for-service-on documented immunization rates during a sec ond period of observation. Methods.-Incentives were given to 57 randomly selected inner-city physician s 4 times at 4-month intervals based on the performance of 50 randomly sele cted children. Coverage from linked records from all sources was determined for a subsample of children within physician offices. Results.-Up-to-date coverage rates documented in the charts increased signi ficantly for children in the bonus group (49.7% to 55.6%; P < .05) and the enhanced fee-for-service group (50.8% to 58.2%; P < .01) compared with the control group. The number of immunizations given by these physicians did no t change significantly, although the number of immunizations given by other s and documented by physicians in the bonus group did increase (P < .05). U p-to-date coverage for all groups increased from 20 to 40 percentage points when immunizations front physician charts were combined with other sources . Conclusions.-Both financial incentives produced a significant increase in c overage levels. Increases were primarily due to better documentation not to better immunizing practices. The financial incentives appeared to provide motivation to physicians but were not sufficient to overcome entrenched beh avior patterns. However, true immunization coverage was substantially highe r than that documented in the charts.