NCT04634019

Financially-Incentives to Improve Provider Compliance

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

• Status: Active Not Recruiting
• Phase: N/A
• Study type: Interventional
• Enrollment: 600 (actual)
• Sponsor: Swiss Tropical & Public Health Institute · Academic / Other
• Sex: All
• Age: —
• Healthy volunteers: Accepted

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.

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.

Conditions

• Compliant Behavior
• Morbidity;Infant

Interventions

Type	Name	Description
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.

Timeline

• Start date: 2018-01-01
• Primary completion: 2022-09-30
• Completion: 2025-12-31
• First posted: 2020-11-18
• Last updated: 2025-05-23

Locations

2 sites across 2 countries: Democratic Republic of the Congo, Switzerland