The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates.

Fairbrother, Gerry; Hanson, Karla L.; Friedman, Samuel; Butts, Gary C.

doi:10.2105/ajph.89.2.171

Cited by 200 publications

(121 citation statements)

References 10 publications

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“…2,3 Delivered by state and regional health departments to vaccine providers, AFIX consists of a brief consultation in which an immunization specialist evaluates a clinic' s vaccine coverage levels and works with providers to set goals for improvement. For early childhood vaccines, this low-cost strategy of "assessment and feedback" increases coverage by 4 to 7 percentage points 3,4 and has received the Community Preventive Services Task Force's strongest recommendation for use. 5 The CDC supports AFIX programs in all 50 states, and it encourages health departments to deliver early childhood AFIX consultations to at least onequarter of federally funded vaccine providers each year.…”

Section: Resultsmentioning

confidence: 99%

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Increasing Provision of Adolescent Vaccines in Primary Care: A Randomized Controlled Trial

2014

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: The Centers for Disease Control and Prevention recommends that health departments in all 50 states deliver AFIX (Assessment, Feedback, Incentives, and eXchange) consultations to 25% of federally funded vaccine providers each year. AFIX effectively raises vaccination coverage among young children.WHAT THIS STUDY ADDS: AFIX consultations achieved short-term gains in coverage for 11-to 12-year-olds for vaccines in the adolescent platform. No gains occurred for older adolescents or over the long term. Consultations were equally effective when delivered in-person or by webinar. abstract OBJECTIVES: To assess the effectiveness of in-person and webinardelivered AFIX (Assessment, Feedback, Incentives, and eXchange) consultations for increasing adolescent vaccine coverage. METHODS:We randomly assigned 91 primary care clinics in North Carolina, serving 107 443 adolescents, to receive no consultation or an in-person or webinar AFIX consultation. We delivered in-person consultations in April through May 2011 and webinar consultations in May through August 2011. The state' s immunization registry provided vaccine coverage data for younger patients (ages 11-12 years) and older patients (ages 13-18 years) for 3 adolescent vaccines: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap); meningococcal; and human papillomavirus (HPV) vaccines ($1 dose, females only). RESULTS:At the 5-month follow-up, AFIX consultations increased vaccine coverage among younger adolescents. Patients in the in-person arm experienced coverage changes that exceeded those in the control arm for Tdap (3.4% [95% confidence interval (CI): 2.2 to 4.6]), meningococcal (4.7% [95% CI: 2.3 to 7.2], and HPV (1.5% [95% CI: 0.3 to 2.7]) vaccines. Patients in the webinar versus control arm also experienced larger changes for these vaccines. AFIX did little to improve coverage among older adolescents. At 1 year, the 3 arms showed similar coverage changes. The effectiveness of in-person and webinar consultations was not statistically different at either time point (all, P ..05).CONCLUSIONS: Webinar AFIX consultations were as effective as in-person consultations in achieving short-term increases in vaccine coverage for younger adolescents. AFIX consultations for adolescents need improvement to have a stronger and more durable impact, especially for HPV vaccine. Pediatrics 2014;134:e346-e353 AUTHORS:

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Section: Resultsmentioning

confidence: 99%

“…7 It had power to detect a change in vaccine coverage of ∼2 percentage points, which we considered adequate given that AFIX consultations have been shown to increase early childhood vaccination by 4 to 7 percentage points. 3,4 The North Carolina Division of Public Health institutional review board approved the study.…”

Section: Clinic Selectionmentioning

confidence: 99%

Increasing Provision of Adolescent Vaccines in Primary Care: A Randomized Controlled Trial

2014

PEDIATRICS

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“…Performance-based payment schemes (also known as target payments) establish performance indicators and targets and give health providers -as individuals or groups -financial incentives to achieve these targets. Bonus payments in the US and UK have led to increases in immunization, smoking cessation, and cervical cancer screening [27][28][29][30][31]. Overall, however, results have been mixed [32][33].…”

Section: Discussionmentioning

confidence: 99%

Strategies that promote high quality care in Indonesia

Barber

Gertler

2008

Health Policy

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Objectives-To investigate factors predicting the quality of care received using a nationally representative dataset from Indonesia.Data Sources-The study combines two surveys in 13 provinces: a household survey of 2451 women who delivered a live birth in 1992-1998, and a facility survey that measured quality available from outpatient providers.Study design-Multivariate regressions are used to explain the quality of care received. Explanatory variables are high facility quality, maternal education, household wealth, ethnicity, and insurance.Data collection methods-Facility quality available is measured by adherence to prenatal protocols using a clinical case scenario. Quality received is measured by maternal reports about routine prenatal services received.Principle findings-High facility quality predicts an increase in quality received. Although poor households have access to the same or higher quality care compared with the least poor, the poor receive lower levels of quality. In remote regions, quality received rises with increasing levels of maternal education and household wealth.Conclusions-Improving health provider knowledge, and increasing household financial resources and information could redress inequalities in quality received among the poor and least educated.

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“…There is insufficient literature to make a definitive judgment with regard to either method. 27,28 For practical reasons related to data collection, we recommend a yearly bonus.…”

Section: Payment Structurementioning

confidence: 99%

“…26 However, it should be noted that, in some studies, improvement owed more to improved documentation than to actual changes in care delivery. [27][28][29] Only 3 studies were carried out in the pediatric population, and all targeted preventive care services in the general pediatric health care delivery setting. 26 Despite some ambiguity in early evaluations, the IOM has endorsed ongoing experimentation with pay-for-performance, 30 and payers are enthusiastic about its potential to improve the value of health care purchasing.…”

mentioning

confidence: 99%

Implementing Pay-for-Performance in the Neonatal Intensive Care Unit

et al. 2007

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Pay-for-performance initiatives in medicine are proliferating rapidly. Neonatal intensive care is a likely target for these efforts because of the high cost, available databases, and relative strength of evidence for at least some measures of quality. Pay-for-performance may improve patient care but requires valid measurements of quality to ensure that financial incentives truly support superior performance. Given the existing uncertainty with respect to both the effectiveness of pay-forperformance and the state of quality measurement science, experimentation with pay-forperformance initiatives should proceed with caution and in controlled settings. In this article, we describe approaches to measuring quality and implementing pay-for-performance in the NICU setting. Keywords pay-for-performance programs; quality improvementLarge deficits in quality of care remain more than half a decade after the Institute of Medicine (IOM) provided a blueprint for improvement. 1 In neonatology, there is persistent unexplained variation in health care delivery and outcomes. [2][3][4][5][6][7][8] To date, quality improvement (QI) efforts, either locally or as part of collaborative efforts, have had mixed results. 9-17 The broad-based improvement envisioned by health care payers and the IOM has not occurred. (In this article, we use the term "payer" to mean the broad group of employers, purchasers, insurers, and health care plans that pay for health care services directly or indirectly.)

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The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates.

Cited by 200 publications

References 10 publications

Increasing Provision of Adolescent Vaccines in Primary Care: A Randomized Controlled Trial

Increasing Provision of Adolescent Vaccines in Primary Care: A Randomized Controlled Trial

Strategies that promote high quality care in Indonesia

Implementing Pay-for-Performance in the Neonatal Intensive Care Unit

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