• Sylvia J Hysong, Kate Simpson, Kenneth Pietz, Richard SoRelle, Kristen Broussard Smitham, and Laura A Petersen.
• Michael E. DeBakey VA Medical Center, Houston, TX, USA. sylvia.hysong@va.gov
• Am J Manag Care. 2012 Oct 1; 18 (10): e378-91.

ObjectivesTo examine the impact of financial incentives on physician goal commitment to guideline-recommended hypertension care.Study DesignClinic-level cluster-randomized trial with 4 arms: individual, group, or combined incentives, and control.MethodsA total of 83 full-time primary care physicians at 12 Veterans Affairs medical centers completed web-based surveys measuring their goal commitment to guideline-recommended hypertension care every 4 months and telephone interviews at months 8 and 16. Intervention arm participants received performance-based incentives every 4 months for 5 periods. All participants received guideline education at baseline and audit and feedback every 4 months.ResultsPhysician goal commitment did not vary over time or across arms. Participants reported patient nonadherence was a perceived barrier and consistent follow-up was a perceived facilitator to successful hypertension care, suggesting that providers may perceive hypertension management as more of a patient responsibility (external locus of control).ConclusionsFinancial incentives may constitute an insufficiently strong intervention to influence goal commitment when providers attribute performance to external forces beyond their control.

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