Financially-Incentives to Improve Provider Compliance

Financially-Incentivized Knowledge Assessments to Improve Provider Compliance With Treatment Guidelines: A Randomized Controlled Trial

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.

Study Overview

• Status: Active, not recruiting
• Conditions: Compliant Behavior; Morbidity;Infant
• Intervention / Treatment: Behavioral: Financially incentivized knowledge assessments

Detailed 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.

• Study Type: Interventional
• Enrollment (Actual): 600
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Congo, The Democratic Republic of the
  • Kinshasa, Congo, The Democratic Republic of the
    • Congo Ministry of Public Health
• Switzerland
  • BS
    • Basel, BS, Switzerland, 4051
      • Swiss Tropical and Public Health Institute

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

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

Exclusion Criteria:

• none.

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

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control arm; Providers in control facilities will not receive any additional training or knowledge assessments.
Experimental: Financial incentive arm; 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.	Behavioral: Financially incentivized knowledge assessments; We will conduct quarterly provider knowledge assessments at selected health facilities and will pay facilities a financial 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 will be informed hat every 3 month there will be a knowledge assessment based on these vignettes and that the results will determine the total bonus payment made to the facility.; Other Names: Provider knowledge assessments

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Compliance with integrated management of childhood illness (IMCI) guidelines	Compliance will be measured through up to 8 direct observations of under-5 sick child visits at each facility collected over a four-day period. During each visit, trained observes will document how many of the 10 diagnostic steps specified in the WHO's Integrated Management of Child Illness (IMCI) are followed by the provider. Compliance will be defined as least 8 out of 10 diagnostic processes completed.	Endline (30 months after project start)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Knowledge regarding IMCI guidelines	Knowledge of IMCI guidelines will be assessed through vignettes administered to providers at baseline and endline. A total of five vignettes will be given to providers, each describing a scenario involving a sick child under age 5. An overall knowledge score will be created to measure the extent to which the diagnosis and treatment chosen by providers matches those specified in the nationally used Integrated Management of Child Illness guidelines.	Endline (30 months after project start)

Collaborators and Investigators

• Sponsor: Swiss Tropical & Public Health Institute
• Collaborators: World Bank
• Investigators: Principal Investigator: Gil Shapira, PhD, World Bank

Publications and helpful links

General Publications

• Fink G, Fritsche G, Samaha H, Sese C, Shapira G. Financially incentivized knowledge assessments to improve provider compliance with treatment guidelines: a cluster-randomized controlled trial. Trials. 2022 Mar 21;23(1):227. doi: 10.1186/s13063-022-06129-8.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2018
• Primary Completion (Actual): September 30, 2022
• Study Completion (Estimated): December 31, 2025

Study Registration Dates

• First Submitted: November 6, 2020
• First Submitted That Met QC Criteria: November 11, 2020
• First Posted (Actual): November 18, 2020

Study Record Updates

• Last Update Posted (Actual): April 10, 2024
• Last Update Submitted That Met QC Criteria: April 9, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: financial incentives; provider behavior; vignettes
• Other Study ID Numbers: IncentLearn

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The data collected as part of this project will be made available to researchers through the World Bank's data repository.
• IPD Sharing Time Frame: Upon completion of study
• IPD Sharing Access Criteria: public access
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No