Despite compelling evidence of the benefits of treatment, hypertension is controlled in less than one-quarter of US citizens. Inadequate blood pressure control results in excess cases of coronary artery disease, congestive heart failure, stroke and other diseases. While some of the reasons for poor blood pressure control are due to poor compliance on the part of patients, there is significant under-treatment of hypertension on the part of physicians. In one recent study, people with hypertension received less than 65% of recommended care. Translation of scientific knowledge from trials such as the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial [ALLHATJ into clinical practice and improved health for patients is lagging. Heightened awareness of =bottlenecks"""""""" in the translation of research knowledge into clinical practice has raised enthusiasm about using creative methods, including financial incentives, to improve translation. Indeed, pharmaceutical companies have been using financial incentives to change physician behavior for decades. Using a randomized controlled trial, we will test the effect of explicit physician-level financial incentives to promote translation of findings from the ALLHAT trial into clinical practice and improved control of hypertension in the primary care setting. A total of 130 primary care physicians will be randomized to two study arms: 1) physician-level financial incentive only + audit and feedback; and 2) audit and feedback only. Use of thiazide diuretics among eligible patients according to the ALLHAT study criteria and the proportion of patients achieving goal blood pressure according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure goal will be the pdmary dependent variables. We will use analytic methods appropriate for a cluster-randomized trial, as patients are nested within physicians, who are further nested in hospitals. We will assess whether financial incentives are a cost-effective intervention. Findings from this study will provide critical information needed to implement methods of """"""""paying for performance"""""""" and will be directly applicable to such programs for the 40.5 million Medicare beneficiaries and the more than 18 million individuals cared for in staff-model health care delivery systems.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
3R01HL079173-02S1
Application #
7458181
Study Section
Health Services Organization and Delivery Study Section (HSOD)
Program Officer
Einhorn, Paula
Project Start
2005-09-01
Project End
2012-05-31
Budget Start
2006-06-01
Budget End
2009-05-31
Support Year
2
Fiscal Year
2007
Total Cost
$134,784
Indirect Cost
Name
Baylor College of Medicine
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
051113330
City
Houston
State
TX
Country
United States
Zip Code
77030
Hysong, Sylvia J; Kell, Harrison J; Petersen, Laura A et al. (2017) Theory-based and evidence-based design of audit and feedback programmes: examples from two clinical intervention studies. BMJ Qual Saf 26:323-334
Petersen, Laura A; Ramos, Kate Simpson; Pietz, Kenneth et al. (2017) Impact of a Pay-for-Performance Program on Care for Black Patients with Hypertension: Important Answers in the Era of the Affordable Care Act. Health Serv Res 52:1138-1155
Urech, Tracy H; Woodard, LeChauncy D; Virani, Salim S et al. (2015) Calculations of Financial Incentives for Providers in a Pay-for-Performance Program: Manual Review Versus Data From Structured Fields in Electronic Health Records. Med Care 53:901-7
Petersen, Laura A; Simpson, Kate; Pietz, Kenneth et al. (2013) Effects of individual physician-level and practice-level financial incentives on hypertension care: a randomized trial. JAMA 310:1042-50
Woodard, LeChauncy D; Landrum, Cassie R; Urech, Tracy H et al. (2012) Impact of clinical complexity on the quality of diabetes care. Am J Manag Care 18:508-14
Petersen, Laura A; Simpson, Kate; Sorelle, Richard et al. (2012) How variability in the institutional review board review process affects minimal-risk multisite health services research. Ann Intern Med 156:728-35
Hysong, Sylvia J; Simpson, Kate; Pietz, Kenneth et al. (2012) Financial incentives and physician commitment to guideline-recommended hypertension management. Am J Manag Care 18:e378-91
Virani, Salim S; Steinberg, Lynne; Murray, Tyler et al. (2011) Barriers to non-HDL cholesterol goal attainment by providers. Am J Med 124:876-80.e2
Woodard, Lechauncy D; Urech, Tracy; Landrum, Cassie R et al. (2011) Impact of comorbidity type on measures of quality for diabetes care. Med Care 49:605-10
Petersen, Laura A; Urech, Tracy; Simpson, Kate et al. (2011) Design, rationale, and baseline characteristics of a cluster randomized controlled trial of pay for performance for hypertension treatment: study protocol. Implement Sci 6:114

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