This evaluation grant examined ways to maximize primary care providers’ utilization of tobacco cessation services that were available at low cost through a state tobacco control program.  The project tested the impact on providers of two different interventions:  comprehensive performance feedback to providers and financial incentives.  Participating primary care providers were affiliated with 8 practices at two Boston hospitals (Massachusetts General Hospital and Brigham and Women’s Hospital).  One hundred fourteen providers participated in the study.  Participating practices were randomly assigned to receive the comprehensive or minimal feedback condition.  Financial incentives (fee for service or salary incentive) were assigned by hospital.

In the comprehensive feedback condition, providers received quarterly feedback on their rate of referral to the tobacco treatment service and real-time clinical feedback on the outcomes of patients referred to the tobacco treatment service.  The minimal feedback group did not receive this information.  Comparisons were made at the provider and practice level in the comprehensive feedback condition. 

Two different incentives were examined:  fee-for-service reimbursement and a performance-based annual salary incentive.  The fee-for-service reimbursement provided clinicians with $5 for every form that documented completion of the 5 A’s.  Forms were faxed to the tobacco treatment service and the incentive was paid quarterly.  The performance-based salary incentive was part of a set of performance incentives and was awarded if tobacco counseling was documented for 25% of the provider’s current smokers.  The incentive was 0.33% of the current salary, or approximately $425.  The incentive was paid annually. 

The researchers found that feedback increased the target behavior of documenting tobacco counseling.  Fee-for-service payment also increased the target behavior, independently from feedback.  However, the annual salary incentive did not increase documentation of counseling services. 

In addition, this grant examined the relationship between smokers’ satisfaction with health care and their reportings of tobacco intervention made at a primary care visit using the patient surveys.  Satisfaction with both tobacco related care and overall healthcare increased as the intensity of tobacco counseling provided increased, regardless of the readiness of the smoker to quit. 

Citations:

Conroy MB, Majchrzak NE, Regan S, Silverman CB, Schnieder LI, Rigotti NA.  The association between patient-reported receipt of tobacco intervention at a primary care visit and smokers’ satisfaction with their health care.  Nicotine Tob Res 2005;  7(Suppl 1):  S29-S34. 

Conroy MB, Majchrzak NE, Silverman CB, Chang Y, Regan S, Schneider LI, Rigotti NA.  Measuring provider adherence to tobacco treatment guidelines:  A comparison of electronic medical record review, patient survey, and provider survey.  Nicotine Tob Res 2005;  7(Suppl 1):  S35-S43. 

For more information, contact:

Nancy Rigotti, MD
Massachusetts General Hospital
50 Staniford Street, 9th Floor
Boston, MA 02114