Effect of Financial Incentives on Improvement in Medical Quality Indicators for Primary Care

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Figure 1.
Observed and linear mixed model estimated percent of meeting Papanicolaou criterion by group over time.
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Figure 2.
Observed and linear mixed model estimated percent of meeting mammography criterion by group over time.
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Figure 3.
Observed and linear mixed model estimated percent of meeting pediatric immunization criterion by group over time.

Table 1.

Papanicolaou Smears: Chart Reviewed and Percent of Meeting Criterion by Center by Time

Time	Nonincentivized Group^*		Incentivized Group^†		P^‡
Time	Total Charts Reviewed (n)	Charts Meeting Criterion (n [%])	Total Charts Reviewed (n)	Charts Meeting Criterion (n [%])	P^‡
2003
1^st quarter	405	361 (89.14)	443	361 (81.49)	.187
2^nd quarter	102	86 (84.31)	356	307 (86.24)	.545
3^rd quarter	236	215 (91.10)	389	317 (81.49)	.010
4^th quarter	387	358 (92.51)	450	358 (79.56)	.002
2004
1^st quarter	235	210 (89.36)	278	237 (85.25)	.362
2^nd quarter	251	234 (93.23)	289	253 (87.54)	.214
3^rd quarter	199	187 (93.97)	270	241 (89.26)	.078
4^th quarter	167	147 (88.02)	209	192 (91.87)	.316
2005
1^st quarter	246	224 (91.06)	435	402 (92.41)	.390
2^nd quarter	222	163 (73.42)	404	365 (90.35)	.0003
3 ^rd quarter	237	180 (75.95)	420	394 (93.81)	<.0001
4^th quarter	285	227 (79.65)	423	400 (94.56)	<.0001
2006
1^st quarter	291	258 (88.66)	392	361 (92.09)	.087
2^nd quarter	328	296 (90.24)	417	374 (89.69)	.922
3^rd quarter	332	294 (88.55)	425	387 (91.06)	.462
4^th quarter	242	222 (91.74)	305	290 (95.08)	.089
2007
1^st quarter	152	128 (84.21)	335	301 (89.85)	.573
2^nd quarter	282	252 (89.36)	427	387 (90.63)	.686
3^rd quarter	280	240 (85.71)	421	384 (91.21)	.420
4^th quarter	205	187 (91.22)	323	296 (91.64)	.844

* Nonincentivized had a higher percent of meeting Papanicolaou criterion during some early time periods: 3^rd and 4^th quarters of 2003 (P < .05 for all).
† Incentivized had a higher percent of meeting Papanicolaou criterion during some late time periods: 2^nd, 3^rd, and 4^th quarters of 2005 (P < .05 for all).
‡ Within-clinic clustering adjusted.

Table 2.

Mammography: Chart Reviewed and Percent of Meeting Criterion by Center by Time

Time	Nonincentivized Group		Incentivized Group		P^*
Time	Total Charts Reviewed (n)	Charts Meeting Criterion (n [%])	Total Charts Reviewed (n)	Charts Meeting Criterion (n [%])	P^*
2003
1^st quarter	571	518 (90.72)	651	603 (92.63)	.366
2^nd quarter	134	121 (90.30)	535	479 (89.53)	.545
3^rd quarter	392	359 (91.58)	638	579 (90.75)	.588
4^th quarter	615	575 (93.50)	669	609 (91.03)	.227
2004
1^st quarter	242	222 (91.74)	268	253 (94.40)	.985
2^nd quarter	223	211 (94.62)	298	281 (94.30)	.796
3^rd quarter	224	210 (93.75)	301	281 (93.36)	.668
4^th quarter	114	109 (95.61)	153	144 (94.12)	.494
2005
1^st quarter	267	256 (95.88)	370	359 (97.03)	.552
2^nd quarter	339	300 (88.50)	421	405 (96.20)	.002
3^rd quarter	338	300 (88.76)	429	418 (97.44)	.011
4^th quarter	299	272 (90.97)	369	363 (98.37)	.0008
2006
1^st quarter	314	281 (89.49)	404	398 (98.51)	<.0001
2^nd quarter	350	324 (92.57)	414	401 (96.86)	.048
3^rd quarter	344	313 (90.99)	422	410 (97.16)	.026
4^th quarter	288	258 (89.58)	192	184 (95.83)	.196
2007
1^st quarter	272	251 (92.28)	363	343 (94.49)	.463
2^nd quarter	350	326 (93.14)	448	428 (95.54)	.260
3^rd quarter	350	339 (96.86)	420	403 (95.95)	.600
4^th quarter	250	240 (96.00)	279	273 (97.85)	.288

No difference was found between nonincentivized and incentivized before 2^nd quarter 2005, whereas incentivized had a higher percent of meeting mammography criterion from 2^nd quarter 2005 to 3^rd quarter 2006 (P < .05 for all); no difference was found in 2007.
* Within-clinic clustering adjusted.

Table 3.

Pediatric Immunization: Chart Reviewed and Percent of Meeting Criterion by Center by Time

Time	Nonincentivized Group		Incentivized Group		P^*
Time	Total Charts Reviewed (n)	Charts Meeting Criterion (n [%])	Total Charts Reviewed (n)	Charts Meeting Criterion (n [%])	P^*
2001
1^st quarter	30	29 (96.67)	226	221 (97.79)	.582
2^nd quarter	54	51 (94.44)	272	268 (98.53)	.139
3^rd quarter	72	53 (73.61)	248	244 (98.39)	<.0001
4^th quarter	87	60 (68.97)	316	290 (91.77)	.055
2002
1^st quarter	189	135 (71.43)	403	359 (89.08)	.013
2^nd quarter	52	37 (71.15)	149	137 (91.95)	.002
3^rd quarter	207	181 (87.44)	458	425 (92.79)	.056
4^th quarter	211	181 (85.78)	493	462 (93.71)	.017
2003
1^st quarter	207	163 (78.74)	488	331 (67.83)	.092
2^nd quarter	159	118 (74.21)	279	221 (79.21)	.636
3^rd quarter	208	163 (78.37)	405	302 (74.57)	.775
4^th quarter	216	174 (80.56)	495	371 (74.95)	.853
2004
1^st quarter	219	191 (87.21)	511	406 (79.45)	.830
2^nd quarter	179	151 (84.36)	489	472 (96.52)	.0001
3^rd quarter	228	202 (88.60)	488	482 (98.77)	<.0001
4^th quarter	224	201 (89.73)	320	316 (98.75)	<.0001

No difference was found between nonincentivized and incentivized groups in the 1^st and 2^nd quarters of 2001. The incentivized group had a higher percent of meeting pediatric immunization criterion during the 3^rd quarter of 2001; the 1^st, 2^nd, and 4^th quarters of 2002 (P < .05 for all); and the 2^nd to 4^th quarters of 2004 (P < .05 for all).
* Within-clinic clustering adjusted.