Financially-Incentives to Improve Provider Compliance

Swiss Tropical and Public Health (TPH) Institute

Status: Active, not recruiting

Conditions: Compliant Behavior; Morbidity;Infant

Treatments: Behavioral: Financially incentivized knowledge assessments

Study type: Interventional

Funder types: Other

Identifiers

NCT04634019

IncentLearn

Details and patient eligibility

About

The main objective of this study is to assess whether making health financing streams conditional on provider performance on knowledge assessment can increase provider compliance with under-5 case management guidelines.

Full description

The main idea of the intervention is to conduct quarterly provider knowledge assessments at health facilities and to pay facilities a bonus if providers perform well on these tests. For the intervention, 12 clinical vignettes were created. These vignettes cover typical patient cases such as malaria, diarrhea and respiratory infections, and assess providers' ability to correctly diagnose and treat hypothetical questions. All medical staff members were informed hat every 3 month there would be a knowledge assessment based on these vignettes and that the results would determine the total bonus payment made to the facility.

Each quarter, facilities receive a supervision visit. During the supervision visits, one provider is randomly chosen for the knowledge assessments, and is tested on two randomly chosen vignette cases.

In order to create a quarterly performance score, the scores on the two vignettes are then averaged. Fifty percent of the overall facility quality score is determined by the general quality checklist that captures basic structural and process features of the facility. The remaining fifty percent are directly determined by the providers' performance on the knowledge assessments. If the overall quality score is below 50%, no quality payments are made. If the quality score is >=50%, facilities can receive a top-up payment of up to 25% of the quantity-based payments. The total bonus percentage is determined by multiplying the quality score (with ranges between 0 and 100%) with the maximum 25% bonus.

Enrollment: 600 patients

Sex: All

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• all providers working at the 110 facilities selected for the study will be included in the study.

Exclusion criteria

• none.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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600 participants in 2 patient groups

Control arm

No Intervention group

Description:

Providers in control facilities will not receive any additional training or knowledge assessments.

Financial incentive arm

Experimental group

Description:

Providers in treatment facilities will be visited once a quarter for a knowledge assessment using vignettes. Facilities performing well in this assessment will receive a quarterly bonus payment, which will be distributed among providers.

Treatment:

Behavioral: Financially incentivized knowledge assessments