Compensation IncentivesNCT05527977
Clinical Documentation Physician Compensation Incentives
A study testing Compensation Incentives to improve Clinical Documentation in people with Compensation Incentives and Clinical Documentation, run by Rush University Medical Center at 1 site in United States.
Trial summary
Clinical documentation which omits significant medical details negatively affects communication among physicians and impedes the diagnostic process. Clinical documentation may be improved by using compensation incentives. Read more about this study
- Who is it for?
- Any ageHealthy volunteers can take part
- Conditions the study is for
- Compensation Incentives, Clinical Documentation, Physician Work Environment
- What is being tested?
- Compensation Incentives to improve Clinical Documentation
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 32 participants
- Where
- 1 siteUnited States
- Study dates
- 26 Sep 2022to 1 Oct 2023
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Who may be able to join
- Physicians, PA's, and NP's at any of 8 pre-selected Rush practice sites.
- Clinical FTE >40%
Who cannot join
- Physicians, PA's, or NP's who have a significant change in clinical FTE or scheduled patient volume during the intervention
- Equitable considerations include: Enrolling all clinicians (MD/DO, PA, NP) at each practice. Physicians with <40% FTE are expected to be eligible to earn low amounts of income from the program (estimated around less than $300 before taxes over 3-month period), hence the investigators will exclude them due to poor motivating force of this total incentive and adverse impacts on the statistical analysis.
Trial locations and contacts
1 site in 1 country.
United States1 site
Rush University Medical Center
Chicago, Illinois, 60612
About this study
Official title: Pilot Demonstration for Physician Compensation Incentives to Improve Diagnostic Specificity in Clinical Documentation
Clinical documentation which omits significant medical details negatively affects communication among physicians and impedes the diagnostic process. Clinical documentation may be improved by using compensation incentives. Therefore, compensation incentives are a compelling mechanism to promote documentation of significant medical details to improve the diagnostic process.
The investigators' proposed project will use physician compensation incentives to improve documentation of clinically significant details for six common diagnoses in outpatient general internal medicine. The investigators will choose clinically significant details which more accurately represent patient complexity, improve the diagnostic process, and have potential to improve patient outcomes. To determine whether compensation incentives improve documentation of clinically significant details, the investigators will compare physicians' baseline documentation to incentivized documentation. The purpose of the investigators' project is to improve communication of clinically significant diagnostic information among physicians, thereby reducing suboptimal treatment plans, overuse, medical error, and cognitive burden upon physicians.
Read the detailed description
Implementation: The investigators' proposed project will use physician compensation incentives to improve documentation of clinically significant details for six common diagnoses in outpatient general internal medicine. The purpose of the program is to improve clinical documentation in order to reduce misdiagnosis and medical errors. The investigators will invite 30-35 primary care physicians in internal medicine and family medicine within Rush University Medical Group to participate. The investigators will review participants' office visit notes for clinical documentation that meets pre-specified criteria. The investigators anticipate that physicians will receive a $5-$10 compensation bonus for each office visit progress note that meets clinical criteria. The investigators' program will be in effect for 3-months. The average performing physician is expected to receive $650-$700 in compensation incentives over the entire 3-month period (higher performing physicians expected to earn $1,000 or above for superior performance).
Approach: To determine whether compensation incentives improve documentation of clinically significant details, the investigators will compare physicians' baseline documentation (during a 6-week run-in period) to incentivized documentation (a 3-month period when physicians will receive compensation incentives for their clinical documentation). Two research assistants will perform retrospective chart review and audits of office visit progress notes. Notes will be scored for whether documentation includes pre-specified clinically significant information. For example, if a patient has had a Deep Vein Thrombosis (DVT), the investigators would assess whether the month of onset of the DVT and duration of anticoagulation therapy was documented in the note. The investigators anticipate that compensation incentives will improve physicians' clinical documentation of clinically significant medical details. The investigators' results will be reported in aggregate at the physician-level.
Participation: 30-35 physicians will be invited to participate in both the incentives program and analysis comparing baseline performance to incentivized performance. If a physician opts out of the analysis, that participant will not be eligible for compensation incentives. The investigators chose a sample of 30-35 physicians so that the study has enough power to detect a significant difference in performance in clinical documentation during the incentivized period compared to baseline.
Risks to patients: The investigators will use patient-level data as covariates in the analysis. The investigators' analysis will occur in a similar fashion as other retrospective studies, whereby patient-level information will be used from individual office visits in the analysis. Patient-level information will be de-identified as quickly as possible and precautions will be made to keep patient and physician-level data secure.
- Conditions
- Compensation Incentives, Clinical Documentation, Physician Work Environment, Diagnostic Error
- Being tested
- Compensation Incentives to improve Clinical Documentation
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Compensation Incentives to improve Clinical DocumentationBehavioural
The investigators have identified six Diagnoses of Interest for the initiative. For each Diagnosis of Interest, the investigators have specified a series of clinically significant diagnostic details. Each physician will receive a compensation bonus from a pool of $20,000 based on the absolute number of times that he or she appropriately documented a Diagnosis of Interest.
The investigators will use SQL Server Management Studio 18.0 to create an initial dataset using ICD-10 codes from office visits during which a Diagnosis of Interest was addressed. The investigators will compare documentation during the 12-week against a 6-week period prior to the intervention. The 6-week period will not be used to determine compensation bonuses. Two blinded research assistants will review H\&P's and progress notes from extracted visits to tabulate the number of times that clinical documentation met expectations.
| Study group | Role | What they receive |
|---|---|---|
| Baseline Period | No intervention | Run-in non-incentivized period for all participants. |
| Incentivized Period | Experimental | 3 month period during which time clinicians will receive compensation incentives for their performance in the program to improve clinical documentation. Receives: Behavioral: Compensation Incentives to improve Clinical Documentation |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change in Clinical Documentation
2 Research assistants will use a binary scoring system for whether or not the documentation for a given diagnosis of interest includes pre-specified diagnostic information at the visit level. The investigators will create this binary scoring system a priori using evidence-based literature about common documentation errors and shortcomings related to the diagnostic process
Measured: Change from baseline documentation over 6 a week period to incentivized documentation over a 12 week period.
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted6 Sep 2022
- Study start26 Sep 2022
- Primary completion16 Dec 2022
- Study completion1 Oct 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Compensation IncentivesStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Model description
- To answer the research question, the investigators will extract data at the visit-level and perform the analysis at the physician-level. The investigators will perform descriptive statistics of physician and patient characteristics. Depending on the distribution of the data, the primary analysis will be paired t-test or Wilcoxon signed rank test comparing 6 weeks of baseline data for each physician to 12 weeks of data with compensation incentives. Performance by each physician during the baseline and incentivized periods will be assessed as a proportion at the visit level. The investigators will perform a multivariate interrupted time series as a sensitivity analysis. Patient and physician variables will be used as covariates in the multivariate analysis. The intevestigators will compare baseline documentation (Arm #1) with incentivized documentation (Arm #2)
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 32 participants (actual)
Sponsor and investigators
- Lead sponsor
- Rush University Medical Center
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, David S. Burstein, Rush University Medical Center
- Investigators
- David S Burstein, MD MS, Principal investigator, Assistant Professor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05527977
- Sponsor's protocol ID
- 22060905-IRB01
- Status last verified
- Jan 2024
- First submitted
- 26 Aug 2022
- Last updated
- 25 Jan 2024
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: Data will be shared only with the research team on record for the study.
Study at a glance
From the registry record, last updated by the sponsor on 25 Jan 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Pilot Demonstration for Physician Compensation Incentives to Improve Diagnostic Specificity in Clinical Documentation
- ClinicalTrials.gov ID
- NCT05527977
- Acronym / sponsor ID
- 22060905-IRB01
- Conditions
- Compensation Incentives, Clinical Documentation, Physician Work Environment, Diagnostic Error
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 32 participants (actual)
- Lead sponsor
- Rush University Medical CenterUniversity, hospital or other
- Study start
- 26 Sep 2022 (actual)
- Primary completion
- 16 Dec 2022 (actual)
- Study completion
- 1 Oct 2023 (actual)
- First posted
- 6 Sep 2022 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Clinical documentation which omits significant medical details negatively affects communication among physicians and impedes the diagnostic process. Clinical documentation may be improved by using compensation incentives. Therefore, compensation incentives are a compelling mechanism to promote documentation of significant medical details to improve the diagnostic process.
The investigators' proposed project will use physician compensation incentives to improve documentation of clinically significant details for six common diagnoses in outpatient general internal medicine. The investigators will choose clinically significant details which more accurately represent patient complexity, improve the diagnostic process, and have potential to improve patient outcomes. To determine whether compensation incentives improve documentation of clinically significant details, the investigators will compare physicians' baseline documentation to incentivized documentation. The purpose of the investigators' project is to improve communication of clinically significant diagnostic information among physicians, thereby reducing suboptimal treatment plans, overuse, medical error, and cognitive burden upon physicians.
Detailed description
Implementation: The investigators' proposed project will use physician compensation incentives to improve documentation of clinically significant details for six common diagnoses in outpatient general internal medicine. The purpose of the program is to improve clinical documentation in order to reduce misdiagnosis and medical errors. The investigators will invite 30-35 primary care physicians in internal medicine and family medicine within Rush University Medical Group to participate. The investigators will review participants' office visit notes for clinical documentation that meets pre-specified criteria. The investigators anticipate that physicians will receive a $5-$10 compensation bonus for each office visit progress note that meets clinical criteria. The investigators' program will be in effect for 3-months. The average performing physician is expected to receive $650-$700 in compensation incentives over the entire 3-month period (higher performing physicians expected to earn $1,000 or above for superior performance).
Approach: To determine whether compensation incentives improve documentation of clinically significant details, the investigators will compare physicians' baseline documentation (during a 6-week run-in period) to incentivized documentation (a 3-month period when physicians will receive compensation incentives for their clinical documentation). Two research assistants will perform retrospective chart review and audits of office visit progress notes. Notes will be scored for whether documentation includes pre-specified clinically significant information. For example, if a patient has had a Deep Vein Thrombosis (DVT), the investigators would assess whether the month of onset of the DVT and duration of anticoagulation therapy was documented in the note. The investigators anticipate that compensation incentives will improve physicians' clinical documentation of clinically significant medical details. The investigators' results will be reported in aggregate at the physician-level.
Participation: 30-35 physicians will be invited to participate in both the incentives program and analysis comparing baseline performance to incentivized performance. If a physician opts out of the analysis, that participant will not be eligible for compensation incentives. The investigators chose a sample of 30-35 physicians so that the study has enough power to detect a significant difference in performance in clinical documentation during the incentivized period compared to baseline.
Risks to patients: The investigators will use patient-level data as covariates in the analysis. The investigators' analysis will occur in a similar fashion as other retrospective studies, whereby patient-level information will be used from individual office visits in the analysis. Patient-level information will be de-identified as quickly as possible and precautions will be made to keep patient and physician-level data secure.
Study design
- Primary purpose
- Health services research
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- To answer the research question, the investigators will extract data at the visit-level and perform the analysis at the physician-level. The investigators will perform descriptive statistics of physician and patient characteristics. Depending on the distribution of the data, the primary analysis will be paired t-test or Wilcoxon signed rank test comparing 6 weeks of baseline data for each physician to 12 weeks of data with compensation incentives. Performance by each physician during the baseline and incentivized periods will be assessed as a proportion at the visit level. The investigators will perform a multivariate interrupted time series as a sensitivity analysis. Patient and physician variables will be used as covariates in the multivariate analysis. The intevestigators will compare baseline documentation (Arm #1) with incentivized documentation (Arm #2)
| Arm | Type | Receives |
|---|---|---|
| Baseline Period | No intervention | –Run-in non-incentivized period for all participants. |
| Incentivized Period | Experimental | Behavioral: Compensation Incentives to improve Clinical Documentation3 month period during which time clinicians will receive compensation incentives for their performance in the program to improve clinical documentation. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (2 listed)
- Physicians, PA's, and NP's at any of 8 pre-selected Rush practice sites.
- Clinical FTE >40%
Key exclusion criteria (2 listed)
- Physicians, PA's, or NP's who have a significant change in clinical FTE or scheduled patient volume during the intervention
- Equitable considerations include: Enrolling all clinicians (MD/DO, PA, NP) at each practice. Physicians with <40% FTE are expected to be eligible to earn low amounts of income from the program (estimated around less than $300 before taxes over 3-month period), hence the investigators will exclude them due to poor motivating force of this total incentive and adverse impacts on the statistical analysis.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Compensation Incentives to improve Clinical DocumentationThe investigators have identified six Diagnoses of Interest for the initiative. For each Diagnosis of Interest, the investigators have specified a series of clinically significant diagnostic details. Each physician will receive a compensation bonus from a pool of $20,000 based on the absolute number of times that he or she appropriately documented a Diagnosis of Interest. The investigators will use SQL Server Management Studio 18.0 to create an initial dataset using ICD-10 codes from office visits during which a Diagnosis of Interest was addressed. The investigators will compare documentation during the 12-week against a 6-week period prior to the intervention. The 6-week period will not be used to determine compensation bonuses. Two blinded research assistants will review H\&P's and progress notes from extracted visits to tabulate the number of times that clinical documentation met expectations. | Behavioural | Incentivized Period |
Primary outcome
Change in Clinical Documentation
Time frame: Change from baseline documentation over 6 a week period to incentivized documentation over a 12 week period.
2 Research assistants will use a binary scoring system for whether or not the documentation for a given diagnosis of interest includes pre-specified diagnostic information at the visit level. The investigators will create this binary scoring system a priori using evidence-based literature about common documentation errors and shortcomings related to the diagnostic process
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 25 Jan 2024.
- Individual participant dataSharing planned: No. Data will be shared only with the research team on record for the study.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
David S Burstein, MD MS principal investigator
Assistant Professor
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Compensation Incentives to improve Clinical Documentation in people with Compensation Incentives and Clinical Documentation, run by Rush University Medical Center at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 25 Jan 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change in Clinical Documentation (time frame: Change from baseline documentation over 6 a week period to incentivized documentation over a 12 week period.). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Jan 2024.