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Financially-Incentives to Improve Provider Compliance

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04634019
Recruitment Status : Recruiting
First Posted : November 18, 2020
Last Update Posted : December 3, 2021
Sponsor:
Collaborator:
World Bank
Information provided by (Responsible Party):
Swiss Tropical & Public Health Institute

Brief 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.

Condition or disease Intervention/treatment Phase
Compliant Behavior Morbidity;Infant Behavioral: Financially incentivized knowledge assessments Not Applicable

Detailed 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.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 500 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description: This will be a two-arm parallel trial - control vs intervention.
Masking: None (Open Label)
Primary Purpose: Health Services Research
Official Title: Financially-Incentivized Knowledge Assessments to Improve Provider Compliance With Treatment Guidelines: A Randomized Controlled Trial
Actual Study Start Date : January 1, 2018
Estimated Primary Completion Date : June 30, 2022
Estimated Study Completion Date : December 31, 2022

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Health Checkup

Arm Intervention/treatment
No Intervention: Control arm
Providers in control facilities will not receive any additional training or knowledge assessments.
Experimental: Financial incentive arm
Providers in treatment facilities will be visited once a quarter for a knowledge assessment using vignettes. Facilities performing well in this assessment will receive a quarterly bonus payment, which will be distributed among providers.
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.
Other Name: Provider knowledge assessments




Primary Outcome Measures :
  1. Compliance with integrated management of childhood illness (IMCI) guidelines [ Time Frame: Endline (30 months after project start) ]
    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.


Secondary Outcome Measures :
  1. Knowledge regarding IMCI guidelines [ Time Frame: Endline (30 months after project start) ]
    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.



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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

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

Exclusion Criteria:

  • none.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT04634019


Contacts
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Contact: Gil Shapira, PhD +1(202) 473-5038 gshapira@worldbank.org
Contact: Hadia Samaha, MS hsamaha@worldbank.org

Locations
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Congo, The Democratic Republic of the
Congo Ministry of Public Health Recruiting
Kinshasa, Congo, The Democratic Republic of the
Contact: Claude Sese, MS         
Switzerland
Swiss Tropical and Public Health Institute Recruiting
Basel, BS, Switzerland, 4051
Contact: Günther Fink, PhD         
Sponsors and Collaborators
Swiss Tropical & Public Health Institute
World Bank
Investigators
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Principal Investigator: Gil Shapira, PhD World Bank
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Responsible Party: Swiss Tropical & Public Health Institute
ClinicalTrials.gov Identifier: NCT04634019    
Other Study ID Numbers: IncentLearn
First Posted: November 18, 2020    Key Record Dates
Last Update Posted: December 3, 2021
Last Verified: November 2021
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: The data collected as part of this project will be made available to researchers through the World Bank's data repository.
Supporting Materials: Study Protocol
Analytic Code
Time Frame: Upon completion of study
Access Criteria: public access

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Swiss Tropical & Public Health Institute:
financial incentives
provider behavior
vignettes