Retrieval of Economic Incentives and Information on Quality-of-care Indicators in Primary Care
Assessment of the Retrieval of Economic Incentives and Information Provision on Quality-of-care Indicators for Primary Care Professionals
1 other identifier
interventional
1,614
1 country
68
Brief Summary
Background: Information provision and economic incentives for professionals are measures aimed at improving quality-of-care in primary care. They are frequently implemented in combination, thus, there is a lack of evidence confirming their individual effectiveness. Since 2006, the Catalan Health Institute (ICS) has implemented a quality improvement system based on a) informing professionals on the result of quality-of-care indicators through an online platform, and simultaneously b) introducing economic incentives in a pay-for-performance (P4P) scheme. There is an unmet need for evidence on the specific impacts of these interventions on quality-of-care. Aims: Overall, the main aim of the study is to analyze the impact of removing information provision and economic incentives on quality-of-care indicators. Specifically, investigators aim (1) to analyze the effect of removing an economic incentive from a quality-of-care indicator, (2) to analyze the effect of removing information provision from an indicator, (3) to evaluate such effects based on the type of indicator, (4) to evaluate potential spillover effects between indicators linked to the same health problem, and (5) to evaluate potential changes in the professionals' registry patterns. Methods: The study will be an unblinded cluster randomized clinical trial, with 3 branches: (1) Control, with no changes in the information/incentive schemes; (2) Removal of the economic incentives from a subset of 7 indicators; (3) Removal of the economic incentives and information linked to the 7 indicators. The study duration will be from February to December 2025, with intermediate analyses at 3, 6 and 9 months. The reference population will be the 68 ICS primary care practices (PCPs) in the regions of Catalunya Central, Penedès and Girona. The primary endpoint will be the monthly quality-of-care indicator result of the 7 indicators, and secondary endpoints will include PCP, professional and patient characteristics. The analysis of the intervention effects will be carried out using mixed models and comparing the evolution of results versus the previous years (2019-2024).
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for not_applicable hypertension
Started Feb 2025
68 active sites
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
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Study Timeline
Key milestones and dates
Study Start
First participant enrolled
February 3, 2025
CompletedFirst Submitted
Initial submission to the registry
February 5, 2025
CompletedFirst Posted
Study publicly available on registry
February 17, 2025
CompletedPrimary Completion
Last participant's last visit for primary outcome
December 31, 2025
CompletedStudy Completion
Last participant's last visit for all outcomes
April 30, 2026
CompletedFebruary 17, 2025
February 1, 2025
11 months
February 5, 2025
February 11, 2025
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Monthly percentage of achievement of the 7 quality-of-care indicators
The result of the quality-of-care indicators is calculated as the % of achievement. This is routinely computed by the Catalan Health Institute Information Systems using the electronic health records.
Evaluation will be carried out at baseline and at months 3, 6, 9 and 12 of the year
Other Outcomes (10)
Monthly percentage of achievement stratified by practice rurality
Baseline and at 1 year
Monthly percentage of achievement stratified by social deprivation index
Baseline and at 1 year
Monthly percentage of achievement stratified by PCP accessibility
Baseline and at 1 year
- +7 more other outcomes
Study Arms (3)
Control
NO INTERVENTIONParticipants in the Control group will not have any change in their information and incentives schemes.
Incentive removal
EXPERIMENTALParticipants will no longer have the economic incentives linked to 7 quality-of-care indicators.
Incentive and information removal
EXPERIMENTALParticipants will no longer have the economic incentives linked to 7 quality-of-care indicators (like in the Incentive removal arm). In addition to this, the information on the indicator results from the online platform for health professionals will be removed.
Interventions
The 7 intervened indicators will be the following: * Blood pressure (BP) control in type-2 diabetes mellitus. * BP control in ischemic cardiopathy/cerebrovascular accident. * Hypertension: BP control in chronic renal insufficiency. * Hypertension: BP control. * Diagnostic adequacy of hypertension. * Correct treatment of atrial fibrillation. * Inhaler verification. Professionals randomized to an arm with this intervention will no longer receive an economic reward for reaching a specific goal in the results of these 7 indicators. The study guarantees no financial loss since the amount of money linked to these incentives will be automatically given to professionals under the concept of participating in the study.
The 7 indicators will be the same as the previous intervention. Professionals randomized to an arm with this intervention will no longer see the following in the online platform: * Numeric result of the indicator. * Color coding to represent indicator result in relation to the yearly goal. * 12-month evolution graph. Next to the 7 indicator names, only the link to a list of patients that are not fulfilling the indicator criteria will be presented (identifying the patients missing a treatment, a control or any other intervention), since this is considered a tool to support clinical practice beyond informing on the result of an indicator.
Eligibility Criteria
You may qualify if:
- Any general practitioner or nurse working in a primary care practice.
- Having enough clinical activity to be included in the pay-for-performance schemes by the PCP director.
- Belonging to a PCP in the regions of Catalunya Central, Penedès or Girona.
- Belonging to a PCP whose director accepted to participate in the study.
You may not qualify if:
- PCPs with very low overall quality-of-care scores (\<60%).
- Professionals who did not sign the pay-for-performance contracts.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (68)
ABS Artés
Artés, Barcelona, 08271, Spain
ABS Berga
Berga, Barcelona, 08600, Spain
ABS Calaf
Calaf, Barcelona, 08280, Spain
ABS Canet de Mar
Canet de Mar, Barcelona, 08360, Spain
ABS Capellades
Capellades, Barcelona, 08786, Spain
ABS Cardona
Cardona, Barcelona, 08261, Spain
ABS Moià
Castellterçol, Barcelona, 08183, Spain
ABS Cubelles-Cunit
Cubelles, Barcelona, 08880, Spain
EAP Penedès Rural Est
Els Monjos, Barcelona, 08730, Spain
EAP Penedès Rural Oest
Els Monjos, Barcelona, 08730, Spain
ABS Baix Berguedà
Gironella, Barcelona, 08680, Spain
ABS Alt Berguedà
Guardiola de Berguedà, Barcelona, 08694, Spain
ABS Igualada urbana
Igualada, Barcelona, 08700, Spain
ABS Anoia Rural
La Pobla de Claramunt, Barcelona, 08787, Spain
ABS Manlleu
Manlleu, Barcelona, 08560, Spain
ABS Manresa-2
Manresa, Barcelona, 08242, Spain
ABS Manresa-4
Manresa, Barcelona, 08243, Spain
ABS Montserrat
Monistrol de Montserrat, Barcelona, 08691, Spain
ABS Navàs/Balsareny
Navàs, Barcelona, 08670, Spain
ABS Piera
Piera, Barcelona, 08784, Spain
ABS Pineda de Mar
Pineda de Mar, Barcelona, 08397, Spain
ABS Lluçanès
Prats de Lluçanès, Barcelona, 08513, Spain
EAP Roda de Ter
Roda de Ter, Barcelona, 08510, Spain
ABS Sallent
Sallent, Barcelona, 08650, Spain
ABS Navarcles - Sant Fruitós de Bages
Sant Fruitós de Bages, Barcelona, 08272, Spain
ABS Sant Hipòlit de Voltregà
Sant Hipòlit de Voltregà, Barcelona, 08512, Spain
ABS Sant Joan de Vilatorrada
Sant Joan de Vilatorrada, Barcelona, 08250, Spain
EAP Ribes-Olivella
Sant Pere de Ribes, Barcelona, 08810, Spain
EAP Roquetes-Canyelles
Sant Pere de Ribes, Barcelona, 08810, Spain
ABS Sant Quirze de Besora
Sant Quirze de Besora, Barcelona, 08580, Spain
ABS Sant Sadurní d'Anoia
Sant Sadurní d'Anoia, Barcelona, 08770, Spain
ABS Sant Vicenç de Castellet
Sant Vicenç de Castellet, Barcelona, 08295, Spain
ABS Santa Eugènia de Berga
Santa Eugènia de Berga, Barcelona, 08507, Spain
ABS Santa Margarida de Montbui
Santa Margarida de Montbui, Barcelona, 08710, Spain
ABS Santpedor
Santpedor, Barcelona, 08251, Spain
ABS Sitges
Sitges, Barcelona, 08870, Spain
ABS Súria
Súria, Barcelona, 08260, Spain
ABS Tona
Tona, Barcelona, 08551, Spain
ABS Tordera
Tordera, Barcelona, 08490, Spain
ABS La Vall de Ges
Torelló, Barcelona, 08570, Spain
ABS Vic-1 Nord
Vic, Barcelona, 08500, Spain
EAP Vilafranca del Penedès-1
Vilafranca del Penedès, Barcelona, 08720, Spain
EAP Vilafranca del Penedès-2
Vilafranca del Penedès, Barcelona, 08720, Spain
ABS Vilanova del Camí
Vilanova del Camí, Barcelona, 08788, Spain
ABS Vilanova i la Geltrú-1
Vilanova i la Geltrú, Barcelona, 08800, Spain
ABS Vilanova i la Geltrú-2
Vilanova i la Geltrú, Barcelona, 08800, Spain
ABS Arbúcies/Sant Hilari
Arbúcies, Girona, 17401, Spain
EAP Bàscara
Bàscara, Girona, 17483, Spain
ABS Besalú
Besalú, Girona, 17850, Spain
ABS Camprodon
Camprodon, Girona, 17867, Spain
ABS Celrà
Celrà, Girona, 17460, Spain
ABS Figueres
Figueres, Girona, 17600, Spain
ABS La Jonquera
la Jonquera, Girona, 17700, Spain
ABS Llançà
Llançà, Girona, 17490, Spain
ABS Olot
Olot, Girona, 17800, Spain
ABS Ripoll
Ripoll, Girona, 17500, Spain
ABS Roses
Roses, Girona, 17480, Spain
ABS Salt
Salt, Girona, 17190, Spain
ABS Sant Feliu de Guíxols
Sant Feliu de Guíxols, Girona, 17220, Spain
ABS Santa Coloma de Farners
Santa Coloma de Farners, Girona, 17430, Spain
ABS Sarrià de Ter
Sarrià de Ter, Girona, 17840, Spain
ABS Sils-Vidreres-Maçanet de la Selva
Sils, Girona, 17410, Spain
EAP Vilafant
Vilafant, Girona, 17740, Spain
ABS Santa Coloma de Queralt
Santa Coloma de Queralt, Tarragona, 43420, Spain
ABS Girona-1
Girona, 17001, Spain
ABS Girona-3
Girona, 17003, Spain
ABS Girona-2
Girona, 17006, Spain
ABS Girona-4
Girona, 17007, Spain
Related Publications (10)
Roland M, Guthrie B. Quality and Outcomes Framework: what have we learnt? BMJ. 2016 Aug 4;354:i4060. doi: 10.1136/bmj.i4060.
PMID: 27492602BACKGROUNDRoland M, Dudley RA. How Financial and Reputational Incentives Can Be Used to Improve Medical Care. Health Serv Res. 2015 Dec;50 Suppl 2(Suppl 2):2090-115. doi: 10.1111/1475-6773.12419. Epub 2015 Nov 17.
PMID: 26573887BACKGROUNDAllen T, Whittaker W, Kontopantelis E, Sutton M. Influence of financial and reputational incentives on primary care performance: a longitudinal study. Br J Gen Pract. 2018 Dec;68(677):e811-e818. doi: 10.3399/bjgp18X699797. Epub 2018 Nov 5.
PMID: 30397016BACKGROUNDEijkenaar F, Emmert M, Scheppach M, Schoffski O. Effects of pay for performance in health care: a systematic review of systematic reviews. Health Policy. 2013 May;110(2-3):115-30. doi: 10.1016/j.healthpol.2013.01.008. Epub 2013 Feb 4.
PMID: 23380190BACKGROUNDRoland M, Campbell S. Successes and failures of pay for performance in the United Kingdom. N Engl J Med. 2014 May 15;370(20):1944-9. doi: 10.1056/NEJMhpr1316051. No abstract available.
PMID: 24827040BACKGROUNDWagenschieber E, Blunck D. Impact of reimbursement systems on patient care - a systematic review of systematic reviews. Health Econ Rev. 2024 Mar 16;14(1):22. doi: 10.1186/s13561-024-00487-6.
PMID: 38492098BACKGROUNDMendelson A, Kondo K, Damberg C, Low A, Motuapuaka M, Freeman M, O'Neil M, Relevo R, Kansagara D. The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care: A Systematic Review. Ann Intern Med. 2017 Mar 7;166(5):341-353. doi: 10.7326/M16-1881. Epub 2017 Jan 10.
PMID: 28114600BACKGROUNDZaresani A, Scott A. Is the evidence on the effectiveness of pay for performance schemes in healthcare changing? Evidence from a meta-regression analysis. BMC Health Serv Res. 2021 Feb 24;21(1):175. doi: 10.1186/s12913-021-06118-8.
PMID: 33627112BACKGROUNDChauhan BF, Jeyaraman MM, Mann AS, Lys J, Skidmore B, Sibley KM, Abou-Setta AM, Zarychanski R. Behavior change interventions and policies influencing primary healthcare professionals' practice-an overview of reviews. Implement Sci. 2017 Jan 5;12(1):3. doi: 10.1186/s13012-016-0538-8.
PMID: 28057024BACKGROUNDComa E, Ferran M, Mendez L, Iglesias B, Fina F, Medina M. Creation of a synthetic indicator of quality of care as a clinical management standard in primary care. Springerplus. 2013 Dec;2(1):51. doi: 10.1186/2193-1801-2-51. Epub 2013 Feb 13.
PMID: 23450738BACKGROUND
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Study Design
- Study Type
- interventional
- Phase
- not applicable
- Allocation
- RANDOMIZED
- Masking
- NONE
- Purpose
- OTHER
- Intervention Model
- PARALLEL
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Head of Research, Innovation and Data Analysis
Study Record Dates
First Submitted
February 5, 2025
First Posted
February 17, 2025
Study Start
February 3, 2025
Primary Completion
December 31, 2025
Study Completion
April 30, 2026
Last Updated
February 17, 2025
Record last verified: 2025-02
Data Sharing
- IPD Sharing
- Will not share