Primary Care Clinical Excellence Incentive Study

NCT04237883 | Completed

• 1 other identifier: 12345
• Study Type: interventional
• Target: 225
• Locations: 1 country
• Sites: 1

Brief Summary

As part of UCLA Health's commitment to developing a premier integrated health system built on a foundation of physician-led, team-based primary care, the Department of Medicine (DOM) recently implemented a new performance based incentive plan called the Primary Care Clinical Excellence (PCCE) Incentive Plan. This incentive plan was developed to motivate providers to improve health maintenance screening rates. The UCLA Health DOM Quality team is leading the implementation and evaluation of this new incentive plan across our primary care network. In addition, the DOM Quality team has partnered with the UCLA Anderson School of Management to study the most efficacious ways to frame and communicate performance based incentives. Understanding the factors that motivate physicians to deliver the highest quality primary care will provide pivotal insights into the successful implementation of performance based programs nationwide. The investigators believe that physicians who receive communication built on behavioral principles will demonstrate more motivation towards and success at meeting national primary care screening guidelines.

Conditions

Behavioral Economics; Primary Health Care; Health Maintenance; Diabetes; Colorectal Cancer Screening; Cervical Cancer Screening; Chlamydia Screening; HPV Screening

Keywords

Behavioral Economics; Primary Health Care; Health Maintenance; Physician Reimbursement

Outcome Measures

Primary Outcomes (1)

• Aggregate Focus Quality Measure order rates at the first visit

  For each patient who visits a given PCP in our sample from November 5, 2019 to March 3, 2020, we will consider all Focus Quality Measures open at his/her first visit to the PCP, and calculate the percent of these measures ordered within 7 days following his/her first visit. Focus Quality Measures include: Diabetes HGB A1C, Diabetes Eye Exam, Diabetes Foot Exam, Diabetes Nephropathy Monitoring, Colon Cancer Screening, Breast Cancer screening, Cervical Cancer Screening, chlamydia screening, and HPV depending on primary care specialty. These Focus Measures are based on the USPSTF primary care recommendations. \[Note: The original intent was to run the study over an eight month period - from November 1, 2019 through June 30, 2020 - but was cut short due to the COVID-19 pandemic. Our revised time frame includes (1) four full cycles (months) of the intervention (11/05/2019-03/03/2020) and four months prior to the experiment as a baseline period\]

  9 months

Secondary Outcomes (19)

• Aggregate Focus Quality Measure completion rates measured at the patient level

  13 months

• Individual Focus Quality Measure order status at the first visit

  9 months

• Individual Focus Quality Measure completion status at the patient level

  13 months

• Complementary Health Maintenance order rate at the first visit

  9 months

• Complementary Health Maintenance completion rate at the patient level

  13 months

Study Arms (3)

Arm 1: Standard Communication Arm

PLACEBO COMPARATOR

Monthly email communication: Monthly standard communication via email informing physicians of their health maintenance completion rate over the prior three-month period. The email will also include a link to the performance dashboard, a link to a FAQ page that outlines their incentive plan, a link to helpful resources such as care guidelines, key tips from top performers, the quality measure on which they are performing the best, and the two quality measures that they could improve on the most.

Behavioral: Standard communication email

Arm 2: Arm 1 Message + Social Comparison Intervention

EXPERIMENTAL

Monthly email communication as in Arm 1 Social comparison: In addition to the information given in Arm 1 email messaging, physicians in this arm will receive a list of the names of the top 25 performers from the prior month, and a high performer benchmark. Each physician in this group will receive a personalized message and subject line based on where in the performance distribution they fall (categories: top 25 performers, high performers, nearly high performers, and low performers). Message content will incorporate language utilizing principles of social comparison theory.

Behavioral: Standard communication email; Behavioral: Social comparison Intervention

Arm 3: Arm 2 Interventions + Leadership training

EXPERIMENTAL

Monthly email communication as in Arm 1 and Arm 2. Social comparison as in Arm 2. Quality improvement leadership training: Physician leads and clinic managers within clinics randomized to Group 3 will receive an in-person quality improvement and primary care clinic performance training, using the principles of quality improvement, self-determination theory and social comparison. Clinic leaders will be trained on how to guide these conversations, formulate their own performance/quality improvement goals, design effective strategies to reach these goals, and track their clinic's progress. Check-in emails and calls will be provided on a monthly basis to follow up on clinic-based quality improvement efforts and share key take-aways from the new Primary Care Clinical Excellence Recognition Program. This program aims to support a positive and collaborative culture of clinical excellence by recognizing and sharing best practices from high performing physicians and clinical teams.

Behavioral: Standard communication email; Behavioral: Social comparison Intervention; Behavioral: Leadership Training

Interventions

Standard communication email BEHAVIORAL

This is the base communication that all physicians will receive.

Arm 1: Standard Communication Arm; Arm 2: Arm 1 Message + Social Comparison Intervention; Arm 3: Arm 2 Interventions + Leadership training

Social comparison Intervention BEHAVIORAL

The social comparison is added onto the standard communication email to provide some peer comparison between the physicians.

Arm 2: Arm 1 Message + Social Comparison Intervention; Arm 3: Arm 2 Interventions + Leadership training

Leadership Training BEHAVIORAL

Clinic and Physician leads will be provided with a clinic leadership training seminars in leadership, quality improvement, and support from the Quality Improvement team at UCLA Health.

Arm 3: Arm 2 Interventions + Leadership training

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Primary care physicians within the UCLA Health Department of Medicine Primary Care Network and with the following specialties: Internal Medicine, Geriatrics, Internal Medicine/Pediatrics, or Family Medicine.
• Clinical full-time employee level (FTE) of ≥ 40% at the beginning of the intervention period.
• Eligible to receive performance-based financial incentive as determined by the Department of Medicine.
• Panel size \>50 patients before the first intervention email was sent
• Patients, with at least one Health Maintenance topic open before or during at least one visit that takes place with a physician enrolled in the study between November 5, 2019 and March 3, 2020.

You may not qualify if:

• Not a primary care physician within the UCLA Health Department of Medicine Primary Care Network.
• Not a primary care physician with the following specialties: Internal Medicine, Geriatrics, Internal Medicine/Pediatrics, or Family Medicine.
• Clinical FTE \< 40%.
• Not eligible to receive performance-based financial incentive as determined by the Department of Medicine.
• Panel size greater than 50 patients before the first intervention email was sent.
• Patients that are not seen by a provider enrolled in the study period.
• Patients seen by physician in the study with no Health Maintenance topics open before or during any visit that takes place between November 5, 2019 and March 3, 2020.

Sponsors & Collaborators

• University of California, Los Angeles: lead

Study Sites (1)

UCLA Health Department of Medicine, Quality Office

Brentwood, California, 90095, United States

Location

MeSH Terms

Conditions

Diabetes Mellitus

Condition Hierarchy (Ancestors)

Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Primary Care Physician

Model Details: Parallel cluster randomized trial. Groups will be clustered at the clinic level taking into consideration total Clinical FTE, Primary Care network group, and baseline HM completion rates.

Study Record Dates

• First Submitted: December 25, 2019
• First Posted: January 23, 2020
• Study Start: November 1, 2019
• Primary Completion: November 1, 2020
• Study Completion: January 1, 2021
• Last Updated: January 26, 2021

Record last verified: 2021-01

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)