Clinical Practice Intensity: Comparing Veterans Affairs (VA) to Private Sector Physicians

Clinical Practice Intensity: Comparing VA to Private Sector Providers

This is a national physician mail survey examining primary care practice patterns. The experimental component of the study (the clinical trial) is a randomized trial of different monetary incentive forms and amounts for physicians invited to participate in the study. Only non-VA physicians will be included in this part of the study. (VA physicians are not allowed to receive monetary incentives.) Physicians will be randomized to receive one of four incentives. The main outcome measure is the response rate.

Study Overview

• Status: Completed
• Conditions: Physician Survey Response Rates
• Intervention / Treatment: Other: $20 cash; Other: $50 cash; Other: $50 check; Other: $100 check

Detailed Description

This primary care physician survey is being conducted by Harris Interactive, an international survey research firm working collaboratively under contract to VA investigators heading the study. Surveys will be mailed to a random sample of 1000 non-VA primary care general internists practicing 20 or more clinical hours per week, identified via the Physician Masterfile of the American Medical Association.

The initial survey mailing, delivered via USPS Priority Mail, will include a cover letter inviting the physician to participate, a 12-page survey booklet (including a cover page, a 9-page survey, and 2 blank pages), a monetary incentive, and a prepaid addressed return envelope. The survey is estimated to take 20 minutes to complete. All survey recipients will also have the opportunity, as part of the survey, to request information about practice patterns in their community. Harris Interactive will randomly assign all invited (non-VA) physicians to receive one of four incentives, included in the initial survey mailing.

Non-responders will be contacted two additional times (at approximately 2 and 4 weeks following the initial mailing) by telephone and by mail. Subsequent mailings will include the survey, a cover letter, and a stamped addressed return envelope, but no monetary incentive.

Response rates will be compared between the four arms of the trial; between check v. cash; and between different denominations.

• Study Type: Interventional
• Enrollment (Actual): 1000
• Phase: Not Applicable

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Primary care general internists in the United States, identified through the AMA Physician Masterfile, who practice at least 20 hours per week are eligible to participate.
• All physicians included in the sample to whom the survey packets are mailed will be included in the analysis of the incentive experiment, except those for whom a survey packet is returned as undeliverable and those non-respondents identified through follow-up procedures as non-locatable, deceased, or retired.

Exclusion Criteria:

- Physicians self-identified in the AMA Masterfile as medical subspecialists or hospitalists are excluded from the sample.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: $20 Cash	Other: $20 cash; $20 cash incentive mailed with survey
Experimental: $50 Cash	Other: $50 cash; $50 cash incentive mailed with survey
Experimental: $50 Check	Other: $50 check; $50 check incentive mailed with survey
Experimental: $100 Check	Other: $100 check; $100 check incentive mailed with survey

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Survey response rate	2 weeks, 2 months (primary), and 6 months after initial mailing

Secondary Outcome Measures

Outcome Measure	Time Frame
Item non-response rates	2 weeks, 2 months (primary), and 6 months after initial mailing

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Collaborators: White River Junction Veterans Affairs Medical Center
• Investigators: Principal Investigator: Brenda E Sirovich, MD MS, White River Junction VA Medical Center, White River Junction, VT

Publications and helpful links

General Publications

• Sirovich BE, Gottlieb DJ, Welch HG, Fisher ES. Regional variations in health care intensity and physician perceptions of quality of care. Ann Intern Med. 2006 May 2;144(9):641-9. doi: 10.7326/0003-4819-144-9-200605020-00007.
• Robertson DJ, Sirovich BE. Colorectal cancer risk following a negative colonoscopy. JAMA. 2006 Nov 22;296(20):2437; author reply 2437-8. doi: 10.1001/jama.296.20.2437-a. No abstract available.
• Sirovich BE, Woloshin S, Schwartz LM. Too Little? Too Much? Primary care physicians' views on US health care: a brief report. Arch Intern Med. 2011 Sep 26;171(17):1582-5. doi: 10.1001/archinternmed.2011.437.

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2009
• Primary Completion (Actual): June 1, 2010
• Study Completion (Actual): December 1, 2010

Study Registration Dates

• First Submitted: February 27, 2009
• First Submitted That Met QC Criteria: February 27, 2009
• First Posted (Estimate): March 2, 2009

Study Record Updates

• Last Update Posted (Actual): October 6, 2017
• Last Update Submitted That Met QC Criteria: October 4, 2017
• Last Verified: October 1, 2017

More Information

Terms related to this study

• Keywords: Response rate; Physician survey; Mail survey
• Other Study ID Numbers: IIR 03-242; DMS-17632 (Other Grant/Funding Number: White River Junction VAMC)