Primary Care Clinical Excellence Incentive Study (PCCE)

University of California, Los Angeles (UCLA)

Status: Completed

Conditions: Diabetes; Chlamydia Screening; Cervical Cancer Screening; HPV Screening; Primary Health Care; Health Maintenance; Behavioral Economics; Colorectal Cancer Screening

Treatments: Behavioral: Leadership Training; Behavioral: Standard communication email; Behavioral: Social comparison Intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT04237883

12345

Details and patient eligibility

About

As part of UCLA Health's commitment to developing a premier integrated health system built on a foundation of physician-led, team-based primary care, the Department of Medicine (DOM) recently implemented a new performance based incentive plan called the Primary Care Clinical Excellence (PCCE) Incentive Plan. This incentive plan was developed to motivate providers to improve health maintenance screening rates.

The UCLA Health DOM Quality team is leading the implementation and evaluation of this new incentive plan across our primary care network. In addition, the DOM Quality team has partnered with the UCLA Anderson School of Management to study the most efficacious ways to frame and communicate performance based incentives.

Understanding the factors that motivate physicians to deliver the highest quality primary care will provide pivotal insights into the successful implementation of performance based programs nationwide. The investigators believe that physicians who receive communication built on behavioral principles will demonstrate more motivation towards and success at meeting national primary care screening guidelines.

Full description

Currently, UCLA Health has 42 primary care clinics staffed with approximately 205 PCP's serving more than 300,000 patients. In order to improve health maintenance screening rates associated with the performance based program, the investigators will use a communication strategy that leverages behavioral principles to motivate providers to improve health maintenance screening rates.

The investigators will implement a three-arm experimental communication campaign that includes monthly messages. The communication strategy will utilize behavioral change theory (particularly social comparison and recognition) to improve physician performance in health maintenance quality metrics.

This study will primarily focus on one quality domain of the PCCE incentive program-Clinical Quality. Two further quality domains of the PCCE incentive program will serve as exploratory measures: Patient Experience and Professional Participation.

For the primary outcome measure and high-priority secondary outcome measures, the investigators will first evaluate whether the combination of arms 2 and 3 differs from arm 1 in terms of the measures listed in the Outcome Measures section. If this comparison is statistically significant, the investigators will next compare arms 1 vs 2. and then, if also significant, the investigators will compare arms 1 vs 3 and 2 vs 3. For the 1 vs 3 and 2 vs 3 comparisons, we will use a Holm-Bonferroni p-value correction. These comparisons of treatment arms will be performed at the patient level using a mixed effects regression model, including random physician and clinic effects to account for clustering of patients. Control variables include (1) patient baseline order rates (or completion rates depending on the outcome measure) in July-October 2019, (2) patient characteristics (age, gender, comorbidity, insurance plan, zip code), and (3) physician characteristics (gender, race, years practiced, years at UCLA Health). Unless otherwise specified, p-values less than 0.05 will be considered statistically significant.

Enrollment: 225 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria

• Primary care physicians within the UCLA Health Department of Medicine Primary Care Network and with the following specialties: Internal Medicine, Geriatrics, Internal Medicine/Pediatrics, or Family Medicine.
• Clinical full-time employee level (FTE) of ≥ 40% at the beginning of the intervention period.
• Eligible to receive performance-based financial incentive as determined by the Department of Medicine.
• Panel size >50 patients before the first intervention email was sent
• Patients, with at least one Health Maintenance topic open before or during at least one visit that takes place with a physician enrolled in the study between November 5, 2019 and March 3, 2020.

Exclusion Criteria:

• Not a primary care physician within the UCLA Health Department of Medicine Primary Care Network.
• Not a primary care physician with the following specialties: Internal Medicine, Geriatrics, Internal Medicine/Pediatrics, or Family Medicine.
• Clinical FTE < 40%.
• Not eligible to receive performance-based financial incentive as determined by the Department of Medicine.
• Panel size greater than 50 patients before the first intervention email was sent.
• Patients that are not seen by a provider enrolled in the study period.
• Patients seen by physician in the study with no Health Maintenance topics open before or during any visit that takes place between November 5, 2019 and March 3, 2020.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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225 participants in 3 patient groups, including a placebo group

Arm 1: Standard Communication Arm

Placebo Comparator group

Description:

Monthly email communication: Monthly standard communication via email informing physicians of their health maintenance completion rate over the prior three-month period. The email will also include a link to the performance dashboard, a link to a FAQ page that outlines their incentive plan, a link to helpful resources such as care guidelines, key tips from top performers, the quality measure on which they are performing the best, and the two quality measures that they could improve on the most.

Treatment:

Behavioral: Standard communication email

Arm 2: Arm 1 Message + Social Comparison Intervention

Experimental group

Description:

Monthly email communication as in Arm 1 Social comparison: In addition to the information given in Arm 1 email messaging, physicians in this arm will receive a list of the names of the top 25 performers from the prior month, and a high performer benchmark. Each physician in this group will receive a personalized message and subject line based on where in the performance distribution they fall (categories: top 25 performers, high performers, nearly high performers, and low performers). Message content will incorporate language utilizing principles of social comparison theory.

Treatment:

Behavioral: Standard communication email

Behavioral: Social comparison Intervention

Arm 3: Arm 2 Interventions + Leadership training

Experimental group

Description:

Monthly email communication as in Arm 1 and Arm 2. Social comparison as in Arm 2. Quality improvement leadership training: Physician leads and clinic managers within clinics randomized to Group 3 will receive an in-person quality improvement and primary care clinic performance training, using the principles of quality improvement, self-determination theory and social comparison. Clinic leaders will be trained on how to guide these conversations, formulate their own performance/quality improvement goals, design effective strategies to reach these goals, and track their clinic's progress. Check-in emails and calls will be provided on a monthly basis to follow up on clinic-based quality improvement efforts and share key take-aways from the new Primary Care Clinical Excellence Recognition Program. This program aims to support a positive and collaborative culture of clinical excellence by recognizing and sharing best practices from high performing physicians and clinical teams.

Treatment:

Behavioral: Standard communication email

Behavioral: Leadership Training

Behavioral: Social comparison Intervention