The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines.
BACKGROUND
This study tested the effects of two organizational support processes, the provision of financial incentives for superior clinical performance and the availability of a patient (smoker) registry and proactive telephone support system for smoking cessation, on provider adherence to accepted practice guidelines and associated patient outcomes.


METHODS
Forty clinics of a large multispecialty medical group practice providing primary care services were randomly allocated to study conditions. Fifteen clinics each were assigned to the experimental conditions "control" (distribution of printed versions of smoking cessation guidelines) and "incentive" (financial incentive pay-out for reaching preset clinical performance targets). Ten clinics were randomized to receive financial incentives combined with access to a centralized patient registry and intervention system ("registry"). Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients' smoking cessation behaviors.


RESULTS
Patients' tobacco use status was statistically significant (P < 0.01) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition. Patients visiting registry clinics accessed counseling programs statistically significantly more often (P < 0.001) than patients receiving care in the control condition. Other endpoints did not statistically significantly differ between the experimental conditions.


CONCLUSIONS
The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practices and patient behaviors was mixed. Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment.
Roski
Joachim
J
National Committee for Quality Assurance, Washington, DC 20036, USA. roski@ncqa.org
Jeddeloh
Robert
R
An
Larry
L
Lando
Harry
H
Hannan
Peter
P
Hall
Carmen
C
Zhu
Shu-Hong
SH
D000554:Ambulatory Care Facilities / Q000191:economics / Q000592:standards; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006302:Health Services Research; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010816:Physician Incentive Plans / Q000191:economics*; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000191:economics / Q000592:standards*; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D011336:Probability; D012016:Reference Values; D012042:Registries; D012052:Reimbursement, Incentive; D016540:Smoking Cessation / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D012944:Social Support; D014481:United States