Retrieval of Economic Incentives and Information on Quality-of-care Indicators in Primary Care

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).

Conditions

• Hypertension
• Diabetes
• Atrium; Fibrillation
• Asthma

Interventions

OTHER

Removal of economic incentives linked to 7 quality-of-care indicators

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.

OTHER

Removal of information provision linked to 7 quality-of-care indicators

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.

Sponsors & Collaborators

• Catalan Institute of Health

  collaborator OTHER_GOV

• Fundacio d'Investigacio en Atencio Primaria Jordi Gol i Gurina

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

OTHER

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2025-02-03

Primary Completion

2025-12-31

Completion

2026-04-30

Countries

• Spain

Study Locations