title: Financial incentives and physician commitment to guideline-recommended hypertension management.
abstract: To examine the impact of financial incentives on physician goal commitment to guideline-recommended hypertension care.
  
  
  
  Clinic-level cluster-randomized trial with 4 arms: individual, group, or combined incentives, and control.
  
  
  
  A total of 83 full-time primary care physicians at 12 Veterans Affairs medical centers completed web-based surveys measuring their goal commitment to guideline-recommended hypertension care every 4 months and telephone interviews at months 8 and 16. Intervention arm participants received performance-based incentives every 4 months for 5 periods. All participants received guideline education at baseline and audit and feedback every 4 months.
  
  
  
  Physician goal commitment did not vary over time or across arms. Participants reported patient nonadherence was a perceived barrier and consistent follow-up was a perceived facilitator to successful hypertension care, suggesting that providers may perceive hypertension management as more of a patient responsibility (external locus of control).
  
  
  
  Financial incentives may constitute an insufficiently strong intervention to influence goal commitment when providers attribute performance to external forces beyond their control.
authors.affiliation: Michael E. DeBakey VA Medical Center, Houston, TX, USA. sylvia.hysong@va.gov
authors.forename: Sylvia J
authors.initials: SJ
authors.lastname: Hysong
authors.forename: Kate
authors.initials: K
authors.lastname: Simpson
authors.forename: Kenneth
authors.initials: K
authors.lastname: Pietz
authors.forename: Richard
authors.initials: R
authors.lastname: SoRelle
authors.forename: Kristen
authors.initials: K
authors.lastname: Broussard Smitham
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
mesh_terms: D001291:Attitude of Health Personnel; D005246:Feedback; D019983:Guideline Adherence; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008485:Medical Audit; D055118:Medication Adherence; D058007:Physicians, Primary Care / Q000193:education; D010818:Practice Patterns, Physicians'; D012052:Reimbursement, Incentive