Randomized Controlled Cluster Trial of Resident Pay for Performance and Cardiovascular Outcomes

Study Overview
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Brief Summary
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The purpose of this study is to determine if a pay for performance model in contrast to the traditional fee for service model may improve the number of patients discharged being treated in accordance with Joint Commission on Health Care JCAHO (a non-for profit organization that accredits health care organizations) standards and standard of care for management of hyperlipidemia In this study the investigators will evaluate these two models by training resident physicians (doctors in training) on JCAHO core measures and specific criteria related to accepted standard of care for acute myocardial infarction and heart failure. The physicians will be randomized to a pay for performance or a fee for service model. Then a medical record review will be performed on patient records that received a discharge diagnosis of myocardial infarction or heart failure and were cared for by the physician subjects

Official Title
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Randomized Controlled Cluster Trial of Resident Pay for Performance and Cardiovascular Outcomes

Conditions
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Myocardial Infarction, Heart Failure

Intervention / Treatment
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* Other: financial compensation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Physician inclusion: Resident physician on the Acute Cardiology Service, the Coronary Care Unit, or the General Medicine Service at the University of Virginia Patient inclusion: discharge diagnosis of heart failure or myocardial infarction. Exclusion Criteria: Residents that are part of the study team

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: pay for performance<br> | Other: financial compensation<br>* financial monetary reimbursement<br>|
| No Intervention: no pay for performance<br> | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| compliance with composite pay for performance measure | In patients discharged from the Coronary Care Unit, Acute Coronary Care Service, or General Medical Service with the discharge diagnosis of either heart failure or myocardial infarction, there is no difference in the rate of compliance with the composite score (see below; Heart Failure Score or Myocardial Infarction Score) between physicians reimbursed in a pay for performance scheme and those who receive no additional reimbursement. | 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| heart failure composite score | In patients discharged from the Coronary Care Unit, Acute Coronary Care Service, or General Medical Service with the discharge diagnosis of heart failure there is no difference between rate of compliance with Heart Failure Score between physicians reimbursed in a pay for performance scheme and those who receive no additional reimbursement. | 1 month | 
| myocardial infarction score | In patients discharged from the Coronary Care Unit, Acute Coronary Care Service, or General Medical Service with the discharge diagnosis of myocardial infarction there is no difference between the rate of compliance with Myocardial Infarction Score between physicians reimbursed in a pay for performance scheme and those who receive no additional reimbursement. | 1 month | 
| readmission rate | In patients discharged from the Coronary Care Unit, Acute Coronary Care Service, or General Medical Service with the discharge diagnosis heart failure there is no difference between 30-day readmission rate between patients that had an appointment less than 7 days and those that did not. | 30 days |