MedicalResearch.com Interview with:
Dr. Lauren Lapointe-Shaw, MD
Physician at University Health Network
Department of Medicine
University of Toronto
MedicalResearch.com: What is the background for this study?
Response: Readmissions after hospital discharge are common and costly. We would like to reduce these as much as possible. Early physician follow-up post hospital discharge is one possible strategy to reduce readmissions. To this end, incentives to outpatient physicians for early follow-up have been introduced in the U.S. and Canada. We studied the effect of such an incentive, introduced to Ontario, Canada, in 2006.
MedicalResearch.com: What are the main findings?
Response: There was good uptake of the incentive as over half of eligible physicians made a claim for the incentive at some point during the study. Despite this, there was no change in rates of early follow-up (7- or 14-day) after the introduction of the incentive. Even physicians with the highest incentive uptake did not demonstrate a change in follow-up rates after incentive introduction; they had the highest follow-up rates both before and after the incentive was introduced.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: This was the first study of the impact of a financial incentive to outpatient physicians on early follow-up after hospital discharge. The financial incentive offered to outpatient physicians in Ontario did not change follow-up rates.
The success of an incentive is dependent on features of its design, but also on how much control the incentivized group (outpatient physicians) realistically has over the desired outcome. Certain features of this incentive (delayed payment, payment mixed with other fee for service billings) may have hindered its success. However, it is also possible that a lack of supporting processes limited outpatient physicians’ ability to change their follow-up rates. Such processes could include communication systems to connect outpatient and hospital physicians, as well as supports to ensure patients can get to their appointments.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future incentives for follow-up should be informed by an understanding of existing barriers, as well as principles of behavioural psychology. Such incentives should be beta-tested and refined prior to widespread implementation.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Effectiveness of a financial incentive to physicians for timely follow-up after hospital discharge: a population-based time serie Lauren Lapointe-Shaw, Muhammad Mamdani, Jin Luo, Peter C. Austin, Noah M. Ivers, Donald A. Redelmeier, and Chaim M. Bell
CMAJ October 2, 2017 189:E1224-E1229; doi:10.1503/cmaj.170092
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