Clinical trial NCT04634019: Financially-Incentives to Improve Provider Compliance
Official title: Financially-Incentivized Knowledge Assessments to Improve Provider Compliance With Treatment Guidelines: A Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: ACTIVE_NOT_RECRUITING
Phase: NA
Conditions: Compliant Behavior
Morbidity;Infant
Keywords: financial incentives
provider behavior
vignettes
Lead sponsor: Swiss Tropical & Public Health Institute
Sponsor class: OTHER
Collaborators: name: World Bank
First posted: 2020-11-18
Enrollment: 600
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: This will be a two-arm parallel trial - control vs intervention.
Primary purpose: HEALTH_SERVICES_RESEARCH

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.

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.

Eligibility criteria: Inclusion Criteria:

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

Exclusion Criteria:

* none.

Primary outcomes:
measure: Compliance with integrated management of childhood illness (IMCI) guidelines
timeFrame: Endline (30 months after project start)
Secondary outcomes:
measure: Knowledge regarding IMCI guidelines
timeFrame: Endline (30 months after project start)
Other outcomes:
Locations:
city: Kinshasa
country: Congo, The Democratic Republic of the
facility: Congo Ministry of Public Health
city: Basel
country: Switzerland
facility: Swiss Tropical and Public Health Institute
state: BS
Study officials:
affiliation: World Bank
name: Gil Shapira, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Fink G, Fritsche G, Samaha H, Sese C, Shapira G. Financially incentivized knowledge assessments to improve provider compliance with treatment guidelines: a cluster-randomized controlled trial. Trials. 2022 Mar 21;23(1):227. doi: 10.1186/s13063-022-06129-8.