The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates.
The purpose of this study was to examine the effects on immunization coverage of 3 incentives for physicians-a cash bonus for practive-wide increases, enhanced fee for service, and feedback Methods.
Incentives were applied at 4-month intervais 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.
The percentage of children who were up to date for diphtheria, tetanus, and pertussis and Haemophilus influenzae type be 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 immanizations received outside the particapating practice also increased significantly in the bonus group (P<. 01).
Levels of missed opporturnities to immunize were high in all groups and did not change over time.
Physicians'knowledge of contraindications was low.
Conclusions Horuses sharply and rapidly increased immunization coverage 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.
Mots-clés Pascal : Vaccination, Immunoprotection, Prévention, Incitation, Pratique professionnelle, Etats Unis, Amérique du Nord, Amérique, Médecin, Personnel sanitaire, Programme sanitaire, Politique sanitaire, Financement, Enfant, Homme, Honoraires, Communication information, Rémunération, Immunoprophylaxie, Boni
Mots-clés Pascal anglais : Vaccination, Immunoprotection, Prevention, Incentive, Professional practice, United States, North America, America, Physician, Health staff, Sanitary program, Health policy, Financing, Child, Human, Fees, Information communication, Remuneration, Immunoprophylaxis
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0156723
Code Inist : 002B30A05. Création : 16/11/1999.