Incentive payments to British Columbia primary care physicians for chronic disease management: What is the effect on physician practice and patient care?

Project number: 
13-010
Approval date: 
Thursday, August 15, 2013
Principal Investigator: 
McGrail,Kimberlyn
Institution: 
Centre for Health Services and Policy Research (CHSPR)
Funding Agency: 
Canadian Institutes of Health Research(CIHR)
Datasets requested: 
consolidation - census geocodes
PharmaNet
Deaths (BC Vital Statistics Agency)
Consolidation registry (Ministry of Health)
ACG Case Mix Group (Johns Hopkins University)
MSP Practitioner File
Hospital Separations (BC Ministry of Health)
Consolidation - demographic (Ministry of Health)
College of Physicians and Surgeons of BC
Medical Services Plan (BC Ministry of Health)
Research objective: 

Overall objective: We will study the impact of an incentive program for general practitioners on patterns of care, patient outcomes, and total costs.

Research question and hypotheses:
What effect have Chronic Care Annual Bonus and Complex Care Initiative payments had on: continuity of care; hospitalization rates; total cost per patient (GP, specialist, diagnostic, hospital and pharmacy); and disease specific quality indicators (for chronic disease incentives) among patients with qualifying chronic conditions?

Hypothesis 1: Continuity of care increases after the introduction of incentive payments.
Hypothesis 2: Provision of guideline-based care for specific conditions increases after the introduction of incentive payments.
Hypothesis 3: Hospitalization rates (overall admissions, admissions through the emergency department, and condition-specific admissions) decrease after the introduction of incentive payments.
Hypothesis 4: Total health care costs per patient (GP, specialist, diagnostic, hospital, and pharmacy) decrease after the introduction of incentive payments.

Secondary research questions will explore the characteristics of physicians who did and did not bill incentives, the patients for whom incentives were billed and the impact of incentive payments on treatment prevalence for qualifying chronic conditions.

Publications: 

Journal Publication

  • Lavergne MR, Law MR, Peterson S, Garrison S, Hurley J, Cheng L, McGrail K. A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease. Canadian Medical Association Journal. 2016 Oct 18;188(15):E375-83.
  • see ref 1532

    Lavergne MR, Law MR, Peterson S, Garrison S, Hurley J, Cheng L, McGrail K. A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease. Canadian Medical Association Journal. 2016 Oct 18;188(15):E375-83.

Presentation of research material (poster/seminar/lecture etc.)

  • Cost-effectiveness of relational continuity in primary care: A preliminary study. Presented by Alex Choi at the Centre for Health Services and Policy Research Conference on March 9-10, 2017 (researcher, clinician and policy maker audience)

Conference abstract/presentation

  • Practice patterns of recent entrants to family medicine in BC. Presented by Ruth Lavergne at the Canadian Association of Health Services and Policy Research Conference on May 24, 2017 (researcher audience).

Page last revised: September 2, 2019