The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates.
| Autor: | Fairbrother G; Department of Epidemiology and Social Medicine, Bronx, NY 10467, USA. hend101w@wonder.em.edc.gov, Hanson KL, Friedman S, Butts GC |
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| Jazyk: | angličtina |
| Zdroj: | American journal of public health [Am J Public Health] 1999 Feb; Vol. 89 (2), pp. 171-5. |
| DOI: | 10.2105/ajph.89.2.171 |
| Abstrakt: | Objectives: The purpose of this study was to examine the effects on immunization coverage of 3 incentives for physicians--a cash bonus for practice--wide increases, enhanced fee for service, and feedback. Methods: Incentives were applied at 4-month intervals over 1 year among 60 inner-city office-based pediatricians. At each interval, charts of 50 randomly selected children between 3 and 35 months of age were reviewed per physician. Results: The percentage of children who were up to date for diphtheria, tetanus, and pertussis and Haemophilus influenzae type b; polio; and measles-mumps-rubella immunization in the study's bonus group improved by 25.3 percentage points (P < .01). No significant changes occurred in the other groups. However, percentage of immunizations received outside the participating practice also increased significantly in the bonus group (P < .01). Levels of missed opportunities to immunize were high in all groups and did not change over time. Physicians' knowledge of contraindications was low. Conclusions: Bonuses sharply and rapidly increased immunization cover-age in medical records. However, much of the increase was the result of better documentation. A bonus is a powerful incentive, but more structure or education may be necessary to achieve the desired results. |
| Databáze: | MEDLINE |
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