Trial reportAmerican journal of public health1999
The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates.
Trial report in American journal of public health, 1999. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04678271 (Assessment, Feedback, Incentive, Exchange), which is not on this map. Cited by 64 papers, 10 of them syntheses that pooled 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.
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.
Assessment, Feedback, Incentive, Exchange (AFIX-OB) A Customizable Quality Improvement Intervention to Increase Maternal Vaccine Uptake
Who cites it
64 citing papers in PubMed, 10 syntheses or guidelines pooled it.
- Audit and feedback: effects on professional practice.The Cochrane database of systematic reviews · 2025Pooled it
- Identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionals.Implementation science : IS · 2023Pooled it
- Behavioral interventions for vaccination uptake: A systematic review and meta-analysis.Health policy (Amsterdam, Netherlands) · 2023Pooled it
- Payment methods for healthcare providers working in outpatient healthcare settings.The Cochrane database of systematic reviews · 2021Pooled it
- Interventions to increase influenza vaccination rates of those 60 years and older in the community.The Cochrane database of systematic reviews · 2018Pooled it
- Interventions to increase influenza vaccination rates of those 60 years and older in the community.The Cochrane database of systematic reviews · 2014Pooled it
- Audit and feedback: effects on professional practice and healthcare outcomes.The Cochrane database of systematic reviews · 2012Pooled it
- An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes.The Cochrane database of systematic reviews · 2011Pooled it
- Systematic review: Effects, design choices, and context of pay-for-performance in health care.BMC health services research · 2010Pooled it
- Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback.Quality & safety in health care · 2006Pooled it
- The impact of performance incentives on child health outcomes: results from a cluster randomized controlled trial in the Philippines.Health policy and planning · 2014Trial
- Increasing provision of adolescent vaccines in primary care: a randomized controlled trial.Pediatrics · 2014Trial
- Comparing in-person and webinar delivery of an immunization quality improvement program: a process evaluation of the adolescent AFIX trial.Implementation science : IS · 2014Trial
- Initiatives to increase childhood vaccination coverage: an international comparison.Health policy (Amsterdam, Netherlands) · 2025Review
- Prevalence and inclusiveness of pay-for-performance incentives for HPV vaccination.The American journal of managed care · 2025Article
- Gains vs losses in pay-for-performance: Stated preference evidence from a U.S. survey.PloS one · 2025Article
- Comparison of pay-for-performance (P4P) programs in primary care of selected countries: a comparative study.BMC health services research · 2023Article
- Dissemination of Contingency Management for the Treatment of Opioid Use Disorder.Perspectives on behavior science · 2023Article
- Is the maternal health voucher scheme associated with increasing routine immunization coverage? Experience from Bangladesh.Frontiers in public health · 2023Article
- Systematic review on reducing missed opportunities for vaccinations in Latin America.Revista panamericana de salud publica = Pan American journal of public health · 2022Article
4 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
objectivesThe purpose of this study was to examine the effects on immunization coverage of 3 incentives for physicians--a cash bonus for practice--wide increases, enhanced fee for service, and feedback.
methodsIncentives were applied at 4-month intervals 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.
resultsThe percentage of children who were up to date for diphtheria, tetanus, and pertussis and Haemophilus influenzae type b; 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 immunizations received outside the participating practice also increased significantly in the bonus group (P < .01). Levels of missed opportunities to immunize were high in all groups and did not change over time. Physicians' knowledge of contraindications was low.
conclusionsBonuses sharply and rapidly increased immunization cover-age 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.
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Registered trials
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.