Clinical Documentation Physician Compensation Incentives

NCT05527977 | Completed

• 1 other identifier: 22060905-IRB01
• Study Type: interventional
• Target: 32
• Locations: 1 country
• Sites: 1

Brief Summary

Clinical documentation which omits significant medical details negatively affects communication among physicians and impedes the diagnostic process. Clinical documentation may be improved by using compensation incentives. Therefore, compensation incentives are a compelling mechanism to promote documentation of significant medical details to improve the diagnostic process. The investigators' proposed project will use physician compensation incentives to improve documentation of clinically significant details for six common diagnoses in outpatient general internal medicine. The investigators will choose clinically significant details which more accurately represent patient complexity, improve the diagnostic process, and have potential to improve patient outcomes. To determine whether compensation incentives improve documentation of clinically significant details, the investigators will compare physicians' baseline documentation to incentivized documentation. The purpose of the investigators' project is to improve communication of clinically significant diagnostic information among physicians, thereby reducing suboptimal treatment plans, overuse, medical error, and cognitive burden upon physicians.

Conditions

Compensation Incentives; Clinical Documentation; Physician Work Environment; Diagnostic Error

Outcome Measures

Primary Outcomes (1)

• Change in Clinical Documentation

  2 Research assistants will use a binary scoring system for whether or not the documentation for a given diagnosis of interest includes pre-specified diagnostic information at the visit level. The investigators will create this binary scoring system a priori using evidence-based literature about common documentation errors and shortcomings related to the diagnostic process

  Change from baseline documentation over 6 a week period to incentivized documentation over a 12 week period.

Study Arms (2)

Baseline Period

NO INTERVENTION

Run-in non-incentivized period for all participants.

Incentivized Period

EXPERIMENTAL

3 month period during which time clinicians will receive compensation incentives for their performance in the program to improve clinical documentation.

Behavioral: Compensation Incentives to improve Clinical Documentation

Interventions

Compensation Incentives to improve Clinical Documentation BEHAVIORAL

The investigators have identified six Diagnoses of Interest for the initiative. For each Diagnosis of Interest, the investigators have specified a series of clinically significant diagnostic details. Each physician will receive a compensation bonus from a pool of $20,000 based on the absolute number of times that he or she appropriately documented a Diagnosis of Interest. The investigators will use SQL Server Management Studio 18.0 to create an initial dataset using ICD-10 codes from office visits during which a Diagnosis of Interest was addressed. The investigators will compare documentation during the 12-week against a 6-week period prior to the intervention. The 6-week period will not be used to determine compensation bonuses. Two blinded research assistants will review H\&P's and progress notes from extracted visits to tabulate the number of times that clinical documentation met expectations.

Incentivized Period

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Physicians, PA's, and NP's at any of 8 pre-selected Rush practice sites.
• Clinical FTE \>40%

You may not qualify if:

• Physicians, PA's, or NP's who have a significant change in clinical FTE or scheduled patient volume during the intervention
• Equitable considerations include: Enrolling all clinicians (MD/DO, PA, NP) at each practice. Physicians with \<40% FTE are expected to be eligible to earn low amounts of income from the program (estimated around less than $300 before taxes over 3-month period), hence the investigators will exclude them due to poor motivating force of this total incentive and adverse impacts on the statistical analysis.

Sponsors & Collaborators

• Rush University Medical Center: lead

Study Sites (1)

Rush University Medical Center

Chicago, Illinois, 60612, United States

Location

Study Officials

• David S Burstein, MD MS

  Assistant Professor

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: The investigators have two research assistants who will perform retrospective chart review. The participants will not be informed of the incentive used (i.e., participants will now know whether the investigators have control/experimental group nor pre/post design)
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SEQUENTIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Model Details: To answer the research question, the investigators will extract data at the visit-level and perform the analysis at the physician-level. The investigators will perform descriptive statistics of physician and patient characteristics. Depending on the distribution of the data, the primary analysis will be paired t-test or Wilcoxon signed rank test comparing 6 weeks of baseline data for each physician to 12 weeks of data with compensation incentives. Performance by each physician during the baseline and incentivized periods will be assessed as a proportion at the visit level. The investigators will perform a multivariate interrupted time series as a sensitivity analysis. Patient and physician variables will be used as covariates in the multivariate analysis. The intevestigators will compare baseline documentation (Arm #1) with incentivized documentation (Arm #2)

Study Record Dates

• First Submitted: August 26, 2022
• First Posted: September 6, 2022
• Study Start: September 26, 2022
• Primary Completion: December 16, 2022
• Study Completion: October 1, 2023
• Last Updated: January 25, 2024

Record last verified: 2024-01

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)