Evidence map›Paper›PMID 24738530›Full record

ArticleThe American journal of managed care2014

Physician financial incentives and care for the underserved in the United States.

Alyna T Chien, Marshall H Chin, G Caleb Alexander, Hui Tang, Monica E Peek

Abstract read
In one paragraph

Article in The American journal of managed care, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Alyna T Chien300 Longwood Ave, Boston, MA 02115. E-mail: alyna.chien@childrens.harvard.edu.
Marshall H Chin
G Caleb Alexander
Hui Tang
Monica E Peek

Funding

TRANSGENIC COREP60DK020595 · NIDDK · UNIVERSITY OF CHICAGO · PI BELL, GRAEME I · 1985 to 2012
$25.5M
Pilot and Feasibility ProgramP30DK020595 · NIDDK · UNIVERSITY OF CHICAGO · PI Raghavendra G Mirmira · 2013 to 2026
$20.9M
Research Design, Data, and Analytics CoreP30DK092949 · NIDDK · UNIVERSITY OF CHICAGO · PI Ronald T. Ackermann, MARSHALL H CHIN · 2011 to 2026
$10.0M
Research and Mentorship in Improving Diabetes CareK24DK071933 · NIDDK · UNIVERSITY OF CHICAGO · PI CHIN, MARSHALL H · 2005 to 2014
$1.6M
Do Performance Incentives Improve Healthcare Quality for Vulnerable Populations?K08HS017146 · AHRQ · UNIVERSITY OF CHICAGO · PI CHIEN, ALYNA TUNG-MEI · 2007 to 2011
$622k
The Impact of Shared Decision-Making among African-Americans with DiabetesK23DK075006 · NIDDK · UNIVERSITY OF CHICAGO · PI PEEK, MONICA E · 2006 to 2010
$622k
An RCT To Decrease Out-Of-Pocket Prescription CostsK08HS015699 · AHRQ · UNIVERSITY OF CHICAGO · PI ALEXANDER, G. CALEB · 2006 to 2010
$617k
AHRQ HHS K08 HS015699AHRQ HHS K08 HS017146AHRQ HHS K08 HS15699-01A1NIDDK NIH HHS K23 DK075006NIDDK NIH HHS K24 DK071933NIDDK NIH HHS P30 DK020595NIDDK NIH HHS P30 DK092949NIDDK NIH HHS P60 DK020595NIDDK NIH HHS P60 DK20595
6 · The paper itself

Abstract

objectivesTo estimate: (1) the percentage of physicians whose compensation is variable; (2) the frequency at which performance incentives for productivity, care quality, patient satisfaction, and resource use were used to determine compensation; and (3) how much incentives differ for physicians who serve greater percentages of patients who are Medicaid-insured, racial/ethnic minorities, or who face language barriers, versus those who do not. STUDY

designCross-sectional study of 3234 nationally representative physicians responding to the 2008 Center for Studying Health System Change's Health Tracking Physician Survey (HTPS).

methodsWe examined the degree to which practices' percentage of Medicaid revenues and physicians' panel characteristics were associated with physicians' financial incentives using χ² statistics and multivariate logistic regression (adjusting for physician specialty, practice type, and capitation levels, and area-based factors).

resultsCompensation was variable for 69% of respondents, was most frequently tied to productivity (68%), and less often to care quality (19%), patient satisfaction (21%), or resource use (14%). Physicians were significantly less likely to report variable compensation if the percentage Medicaid revenues was 50% or more (adjusted odds ratio [OR] 0.73, 95% confidence interval [CI], 0.57-0.95) or if physician panels were at least 50% Hispanic (adjusted OR 0.74, 95% CI, 0.56-0.99). However, physicians were significantly more likely to report use of all 4 performance incentives if percentage of Medicaid revenues was 6% to 24%.

conclusionsPhysicians report different types of financial incentives designed to alter care quality and quantity; incentive types differ by the degree that practices derive revenues from Medicaid or serve Hispanic patients. Further investigation is needed to understand how to align financial incentives with disparity-reduction efforts.

Indexed as

Vulnerable PopulationsCross-Sectional StudiesHumansLogistic ModelsMedicaidPhysician Incentive PlansPhysiciansUnited States

Identifiers

PMID24738530
PMCPMC4110893

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.