Enhancing Mammography Referral in Primary Care

Grady, Kathleen E.; Lemkau, Jeanne Parr; Lee, B.A. Norma R.; Caddell, M.R.C. Cheryl

doi:10.1006/pmed.1997.0219

Cited by 74 publications

(99 citation statements)

References 12 publications

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“…Three studies (Grady et al 1997;Hillman et al 1998;Hillman et al 1999) didn't detect any significant effect of P4P bonus rewards or bonus rewards combined with performance feedback on physician compliance with cancer screening, pediatric immunization and mammography referrals. Two studies (Fairbrother et al 1999;Fairbrother et al 2001) found that a bonus or bonus with performance feedback incentives increased documented coverage levels for childhood immunization, but the measured increase 6 was primarily due to better documentation not better immunization practices.…”

Section: Empirical Evidence On Physician Response To P4pmentioning

confidence: 96%

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Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Hurley

DeCicca

et al. 2011

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Explicit financial incentives, especially pay-for-performance (P4P) incentives, have been extensively employed in recent years by health plans and governments in an attempt to improve the quality of health care services. This study exploits a natural experiment in the province of Ontario, Canada to identify empirically the impact of pay-for-performance (P4P) incentives on the provision of targeted primary care services, and whether physicians' responses differ by age, practice size and baseline compliance level. We use an administrative data source which covers the full population of the province of Ontario and nearly all the services provided by practicing primary care physicians in Ontario. With an individual-level data set of physicians, we employ a difference-in-differences approach that controls for both "selection on observables" and "selection on unobservables" that may cause estimation bias in the identification. We also implemented a set of robustness checks to control for confounding from the other contemporary interventions of the primary care reform in Ontario. The results indicate that, while all responses are of modest size, physicians responded to some of the financial incentives but not the others. The differential responses appear related to the cost of responding and the strength of the evidence linking a service with quality. Overall, the results provide a cautionary message regarding the effectiveness of pay-for-performance schemes for increasing quality of care.

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Section: Empirical Evidence On Physician Response To P4pmentioning

confidence: 96%

“…Sample size / scale of the experiment Grady et al 1997 RCT, random assignment 3 arms: 20 education and reward; 18 education; 23 control (61 practices in total)…”

Section: Appendix 1--empirical Studies On Physician Response To P4p Imentioning

confidence: 99%

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Hurley

DeCicca

et al. 2011

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“…Christensen et al (14) ascertained significantly improved delivery of cognitive services by pharmacists-e.g., consulting the prescribing clinician regarding a suboptimal dosein response to a modest financial incentive of $4 or $6 for each cognitive service intervention. Grady et al (38) found no effect of a $50 token reward for achieving a 50% referral rate to mammography, based on quarterly audits.…”

Section: Differences By Incented Entitymentioning

confidence: 99%

“…Initially, P4P programs clearly stressed process measures of clinical quality (62), but Rosenthal et al (62) (38,44,45). The preponderance of this evidence suggests some positive efficacy for financial incentives applied to preventive services, but the mixed findings and differing study designs preclude general inferences.…”

Section: Focal Quality Behavior Targeted By Incentive (Structure Promentioning

confidence: 99%

Quality-Based Financial Incentives in Health Care: Can We Improve Quality by Paying for It?

Conrad

Perry

2009

Annu. Rev. Public Health

122

135

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This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. These propositions are evaluated through a synthesis of extant peerreviewed empirical evidence. Comprehensive financial incentivesbalancing rewards and penalties; blending structure, process, and outcome measures; emphasizing continuous, absolute performance standards; tailoring the size of incremental rewards to increasing marginal costs of quality improvement; and assuring certainty, frequency, and sustainability of incentive payoffs-offer the prospect of significantly enhancing quality beyond the modest impacts of prevailing pay-forperformance (P4P) programs. Such organizational innovations as the primary care medical home and accountable health care organizations are expected to catalyze more powerful quality incentive models: riskand quality-adjusted capitation, episode of care payments, and enhanced fee-for-service payments for quality dimensions (e.g., prevention) most amenable to piece-rate delivery.

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“…[9][10][11][12][13][14][15][16] Physicians have identified cost to the patient as a major reason that they do not recommend mammography, and doctors may not recommend mammography to women who they think cannot afford it or will not comply. 14,[17][18][19][20][21] Although many investigators have examined factors related to mammography use, fewer have investigated factors associated with physician recommendation to obtain mammography. In this study, we used self-reported data from the North Carolina Breast Cancer Screening Program to investigate the association between physician recommendation and women's race/ethnicity, socioeconomic status (SES), and other characteristics in a diverse, mostly rural population.…”

Section: Introductionmentioning

confidence: 99%

The association of race/ethnicity, socioeconomic status, and physician recommendation for mammography: who gets the message about breast cancer screening?

2001

Am J Public Health

222

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OBJECTIVES: This study investigated the association between physician recommendation for mammography and race/ethnicity, socioeconomic status, and other characteristics in a rural population. METHODS: In 1993 through 1994, we surveyed 1933 Black women and White women 52 years and older in 10 rural counties. RESULTS: Fifty-three percent of the women reported a physician recommendation in the past year. White women reported recommendations significantly more often than did Black women (55% vs 45%; odds ratio = 1.49). Controlling for educational attainment and income eliminated the apparent racial/ethnic difference. After control for 5 personal, 4 health, and 3 access characteristics, recommendation for mammography was found to be more frequent among women who had access to the health care system (i.e., had a regular physician and health insurance). Recommendation was less frequent among women who were vulnerable (i.e., were older, had lower educational attainment, had lower annual family income). CONCLUSIONS: Socioeconomic status, age, and other characteristics--but not race/ethnicity--were related to reports of a physician recommendation, a precursor strongly associated with mammography use. Efforts to increase physician recommendation should include complementary efforts to help women address socioeconomic and other barriers to mammography use.

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Enhancing Mammography Referral in Primary Care

Cited by 74 publications

References 12 publications

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Quality-Based Financial Incentives in Health Care: Can We Improve Quality by Paying for It?

The association of race/ethnicity, socioeconomic status, and physician recommendation for mammography: who gets the message about breast cancer screening?

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