Effect of a Financial Incentive for Colorectal Cancer Screening Adherence on the Appropriateness of Colonoscopy Orders.
Performance incentives for preventive care may encourage inappropriate testing, such as cancer screening for patients with short life expectancies. Defining screening colonoscopies for patients with a >50% 4-year mortality risk as inappropriate, the authors performed a pre-post analysis assessing the effect of introducing a cancer screening incentive on the proportion of screening colonoscopy orders that were inappropriate. Among 2078 orders placed by 23 attending physicians in 4 academic general internal medicine practices, only 0.6% (n = 6/1057) of screening colonoscopy orders in the preintervention period and 0.6% (n = 6/1021) of screening colonoscopy orders in the postintervention period were deemed "inappropriate." This study found no evidence that the incentive led to an increase in inappropriate screening colonoscopy orders.
1 Geisinger Health System, Danville, PA.
Thomas B
TB
Morland
2 University of Pennsylvania Health System, Philadelphia, PA.
Marie
M
Synnestvedt
2 University of Pennsylvania Health System, Philadelphia, PA.
Steven
S
Honeywell
2 University of Pennsylvania Health System, Philadelphia, PA.
Feifei
F
Yang
3 Massachusetts General Hospital, Boston, MA.
Katrina
K
Armstrong
2 University of Pennsylvania Health System, Philadelphia, PA.
Carmen
C
Guerra
D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D003113:Colonoscopy / Q000706:statistics & numerical data*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D015897:Comorbidity; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D000069342:Medical Overuse / Q000517:prevention & control*; D008875:Middle Aged; D009042:Motivation; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors
colonoscopy; colorectal cancer; pay for performance; quality; screening