This resubmission proposes a randomized controlled trial to assess the impact of a system of periodic feedback and financial incentives on physician compliance with cancer screening guidelines in HealthPASS, Philadelphia's Medicaid HMO. The study will investigate whether the provision of feedback to primary care sites every six months, when linked to a financial bonus program specifically based on the extent of cancer prevention provided, improves on primary care provider attention to prevention for women ages 50 and over. The specific study questions are: 1) does the intervention change adherence to screening guidelines for breast examination, mammography, pap smear, and fecal occult blood testing, and, if so, to what extent; 2) are these four components of cancer prevention affected differently by the intervention; 3) how quickly does the intervention impact on provider behavior; and, 4) how does the magnitude of the effect differ for different types of providers and/or patients? Approximately 100 primary care sites participating in HealthPASS 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 cancer screening guidelines will be determined using computerized scoring algorithms. Experimental group sites will receive detailed feedback on their performance every six months, and sites which perform well and/or improve significantly will receive financial bonuses. The study is significant for several reasons: it focuses on using financial incentives to improve quality of care, rather than to limit utilization and control costs; it uses a prospective, randomized design; it seeks to improve prevention for a traditionally under-served minority population; and, it is being undertaken in a setting which is considered one of the major models for providing care for the indigent and uninsured.
