Financially-Incentives to Improve Provider Compliance

Morbidity;Infant Clinical Trial

Official title:

Financially-Incentivized Knowledge Assessments to Improve Provider Compliance With Treatment Guidelines: A Randomized Controlled Trial

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT04634019
• Other study ID #: IncentLearn
• Status: Active, not recruiting
• Phase: N/A
• Start date: January 1, 2018
• Est. completion date: December 31, 2025

Study information

• Verified date: April 2024
• Source: Swiss Tropical & Public Health Institute
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The main objective of this study is to assess whether making health financing streams conditional on provider performance on knowledge assessment can increase provider compliance with under-5 case management guidelines.

Description:

The main idea of the intervention is to conduct quarterly provider knowledge assessments at health facilities and to pay facilities a bonus if providers perform well on these tests. For the intervention, 12 clinical vignettes were created. These vignettes cover typical patient cases such as malaria, diarrhea and respiratory infections, and assess providers' ability to correctly diagnose and treat hypothetical questions. All medical staff members were informed hat every 3 month there would be a knowledge assessment based on these vignettes and that the results would determine the total bonus payment made to the facility.

Each quarter, facilities receive a supervision visit. During the supervision visits, one provider is randomly chosen for the knowledge assessments, and is tested on two randomly chosen vignette cases.

In order to create a quarterly performance score, the scores on the two vignettes are then averaged. Fifty percent of the overall facility quality score is determined by the general quality checklist that captures basic structural and process features of the facility. The remaining fifty percent are directly determined by the providers' performance on the knowledge assessments. If the overall quality score is below 50%, no quality payments are made. If the quality score is >=50%, facilities can receive a top-up payment of up to 25% of the quantity-based payments. The total bonus percentage is determined by multiplying the quality score (with ranges between 0 and 100%) with the maximum 25% bonus.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 600
• Est. completion date: December 31, 2025
• Est. primary completion date: September 30, 2022
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• all providers working at the 110 facilities selected for the study will be included in the study.

Exclusion Criteria:

• none.

Related Conditions & MeSH terms

• Compliant Behavior
• Morbidity;Infant

Intervention

Behavioral:
• Financially incentivized knowledge assessments
We will conduct quarterly provider knowledge assessments at selected health facilities and will pay facilities a financial bonus if providers perform well on these tests. For the intervention, 12 clinical vignettes were created. These vignettes cover typical patient cases such as malaria, diarrhea and respiratory infections, and assess providers' ability to correctly diagnose and treat hypothetical questions. All medical staff members will be informed hat every 3 month there will be a knowledge assessment based on these vignettes and that the results will determine the total bonus payment made to the facility.

Locations

Country	Name	City	State
Congo, The Democratic Republic of the	Congo Ministry of Public Health	Kinshasa
Switzerland	Swiss Tropical and Public Health Institute	Basel	BS

Sponsors (2)

Lead Sponsor	Collaborator
Swiss Tropical & Public Health Institute	World Bank

Countries where clinical trial is conducted

Congo, The Democratic Republic of the,  Switzerland, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Compliance with integrated management of childhood illness (IMCI) guidelines	Compliance will be measured through up to 8 direct observations of under-5 sick child visits at each facility collected over a four-day period. During each visit, trained observes will document how many of the 10 diagnostic steps specified in the WHO's Integrated Management of Child Illness (IMCI) are followed by the provider. Compliance will be defined as least 8 out of 10 diagnostic processes completed.	Endline (30 months after project start)
Secondary	Knowledge regarding IMCI guidelines	Knowledge of IMCI guidelines will be assessed through vignettes administered to providers at baseline and endline. A total of five vignettes will be given to providers, each describing a scenario involving a sick child under age 5. An overall knowledge score will be created to measure the extent to which the diagnosis and treatment chosen by providers matches those specified in the nationally used Integrated Management of Child Illness guidelines.	Endline (30 months after project start)