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
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.