Do financial incentives improve the treatment of diabetes in Swiss primary care?

INTERVENTION: The level of randomization will be at the practice level. The participating practices will be divided into an intervention and control group. Randomization will be stratified by current performance status (clinical QI blood pressure), number of primary care physicians (PCPs) per practice, network participation of the practice and number of diabetic patients. PCPs contributing to the FIRE database already receive a bimonthly feedback report on their data. Intervention and control group will receive additional intensified feedback reports on the characteristics of their current diabetic patients, including last data of blood pressure and HbA1c measurements. Moreover, recommendations of the current diabetes treatment guidelines and target thresholds of QI will be provided. After randomization, PCPs in the intervention group will additionally be informed that they will receive a financial incentive 12 months after initial feedback provision for increasing achievements regarding the following two QI: 1. Percentage of diabetic patients with blood pressure < 140/85 mmHg (clinical QI) 2. Percentage of patients where HbA1c was measured within the last 12 months (process QI) At baseline, the percentage of patients meeting criteria of each QI will be measured. After one year, the percentage of patients meeting the QI will again be measured. For each improved percentage point, PCPs in the intervention group will be entitled to a singular payment of 75 Swiss francs (CHF). PCPs in the control group will not receive a financial incentive and will not be informed about the provision of incentives in the intervention group. The intervention stops 12 months after baseline, bimonthly intensified feedback reports will continue for another 12 months. 24 months after baseline, performance will be measured again in order to estimate long‐term effects of the incentive. CONDITION: Diabetes mellitus ; Nutritional, Metabolic, Endocrine ; Diabetes mellitus PRIMARY OUTCOME: Obtained from the FIRE database at baseline, 12 and 24 months:; 1. Proportion of diabetic patients with last blood pressure measurement < 140/85 mmHg (clinical QI); 2. Proportion of diabetic patients with at least one measurement of HbA1c in the preceding 12 months (process QI) SECONDARY OUTCOME: Obtained from the FIRE database at baseline, 12 and 24 months:; 1. Proportion of diabetic patients with at least one blood pressure measurement in the preceding 12 months (process QI); 2. Proportion of diabetic patients with HbA1c levels < 7.5% (clinical QI); 3. Proportion of diabetic patients with at least one cholesterol measurement in the preceding 12 months (process QI); 4. Proportion of diabetic patients with total cholesterol < 5 mmol/l (clinical QI) INCLUSION CRITERIA: Up to December 2017, 290 GPs from 14 German speaking cantons of Switzerland participated in the FIRE project. In December 2017, the database contained data of 3,372,343 encounters of 345,811 patients. The FIRE database, consisting of administrative data, vital signs (blood pressure), lab values (Hba1c), diagnostic codes (ICPC‐2), and medication data (ATC codes) provides the database for the project. Structural data on participating GP practices (physicians’ age and training, practice type (single‐handed, double or group practice) and location, laboratory connection) are collected at individual FIRE project entry. PCPs are eligible for the current study based on the FIRE database, if the dataset of 2017 is complete and a minimum threshold of 0.1 is achieved for the process indicators HbA1c and blood pressure, to rule out technical problems. Of the eligible PCPs, primary care patients with diabetes mellitus will be identified from the FIRE database acc