This randomized controlled trial will assess the impact of a system of periodic feedback and financial incentives on compliance with pediatric preventive care clinical guidelines in HealthPASS, a mandatory Medicaid HMO in Philadelphia. The study will investigate whether the provision of detailed feedback reports to sites every six months, linked with a financial bonus program specifically tied to preventive care, improves on the HMO's currently observed pediatrics standards compliance rate of 60 percent. The specific research questions are: 1) does the intervention change adherence to preventive care guidelines, and, if so, to what extent; 2) are different preventive care components affected differently; 3) how quickly does the intervention influence physician behavior; and, 4) how does the magnitude of the effect differ for different types of provider practices? Approximately 51 pediatric primary care sites participating in HealthPASS and meeting study eligibility criteria will be randomly assigned to an experimental or control group. Sites in both groups will be audited once every six months for two years, using HealthPASS' auditing tools and procedures. Compliance with pediatric preventive care guidelines will be determined using computerized scoring algorithms. Experimental sites will receive detailed feedback reports on their performance every six months, and sites which perform well and/or improve substantially will receive financial bonuses. The study is significant for several reasons: it focusses on using financial incentives to improve quality, rather than to limit utilization; it uses a prospective, randomized design, improving on previous research on incentives; it seeks to improve attention to preventive care for a traditionally underserved minority population; and, it is being undertaken in a setting which is considered one of the major models for providing care to the indigent and uninsured.
