title: Financial team incentives improved recording of diagnoses in primary care: a quasi-experimental longitudinal follow-up study with controls.
abstract: BACKGROUND
  In primary care, financial incentives have usually been directed to physicians because they are thought to make the key decisions in order to change the functions of a medical organization. There are no studies regarding the impact that directing these incentives to all disciplines of the care team (e.g. group bonuses for both nurses and doctors) may have, despite the low frequency with which diagnoses were being recorded for primary care visits to doctors. This study tested the effect of offering group bonuses to the care teams.
  
  
  METHODS
  This was a retrospective quasi-experimental study with before-and-after settings and two control groups. In the intervention group, the mean percentage of visits to a doctor for which a diagnosis was recorded by each individual care team (mean team-based percentage of monthly visits to a doctor with recorded diagnoses) and simultaneously the same data was gathered from two different primary care settings where no team bonuses were applied. To study the sustainability of changes obtained with the group bonuses the respective data were derived from the electronic health record system for 2 years after the cessation of the intervention. The differences in the rate of marking diagnoses was analyzed with ANOVA and RM-ANOVA with appropriate post hoc tests, and the differences in the rate of change in marking diagnoses was analyzed with linear regression followed by t-test.
  
  
  RESULTS
  The proportion of doctor visits having recorded diagnoses in the teams was about 55 % before starting to use group bonuses and 90 % after this intervention. There was no such increase in control units. The effect of the intervention weakened slightly after cessation of the group bonuses.
  
  
  CONCLUSIONS
  Group bonuses may provide a method to alter clinical practices in primary care. However, sustainability of these interventions may diminish after ceasing this type of financial incentive.
authors.affiliation: , Espoo, Finland. tuomo.lehtovuori@espoo.fi.
authors.forename: Tuomo
authors.initials: T
authors.lastname: Lehtovuori
authors.affiliation: Department of General Practice and Primary Healthcare, HUS, Institute of Clinical Medicine, University of Helsinki, P.O. Box 20, Tukholmankatu 8 B, 00014, Vantaa, Finland. kauppila@helsinki.fi.
authors.forename: Timo
authors.initials: T
authors.lastname: Kauppila
authors.affiliation: , Espoo, Finland. jouko.kallio@fimnet.fi.
authors.forename: Jouko
authors.initials: J
authors.lastname: Kallio
authors.affiliation: , Vantaa, Finland. marko.raina@vantaa.fi.
authors.forename: Marko
authors.initials: M
authors.lastname: Raina
authors.affiliation: , Espoo, Finland. lasse.suominen@espoo.fi.
authors.forename: Lasse
authors.initials: L
authors.lastname: Suominen
authors.affiliation: Department of Oral and Maxillofacial Diseases, University of Helsinki, Espoo, Finland. amkheik@mappi.helsinki.fi.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Heikkinen
mesh_terms: D000704:Analysis of Variance; D003363:Cost Control / Q000191:economics / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D009819:Office Visits / Q000191:economics* / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000191:economics; D010816:Physician Incentive Plans / Q000191:economics* / Q000458:organization & administration; D058007:Physicians, Primary Care / Q000191:economics*; D011320:Primary Health Care / Q000191:economics* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000191:economics; D012052:Reimbursement, Incentive / Q000191:economics; D012189:Retrospective Studies; D013997:Time Factors