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.
Bibliographical noteFunding Information:
This study was supported in part by a grant from the Robert Wood Johnson Foundation (Grant 036023). The investigators are grateful to Allina Hospitals & Clinics and the management and staff of the Allina Medical Clinic in their support of this effort. The following Allina Medical Clinic sites generously participated in the efforts described in this manuscript: Annandale, Buffalo, Cambridge, Champlin, Cokato, Coon Rapids Family Practice, Coon Rapids Internal Medicine, Coon Rapids Women’s Health, Cottage Grove, Eagan, Edina, Faribault, Farmington, Forest Lake, Fridley Ob/Gyn, Grantsburg, Hastings, Hinkley, Internal Medicine Specialists–St. Paul, Litchfield, Maple Grove, Mora, Nicollet Mall, North Mankato, Northfield, Parkview Maplewood, Parkwood St. Paul, Ramsey, Shakopee, Shoreview, St. Peter, The Doctors, United Family Practice Center, West Health, West St. Paul, Woodbury, and Woodlake.
- Guideline adherence
- Practice guidelines
- Practice management
- Preventive medicine
- Quality of health care
- Smoking cessation