Performance based contracts in healthcare: experimental evaluation of contracting based on inputs and outcomes

Last registered on July 07, 2016

Pre-Trial

Trial Information

General Information

Title
Performance based contracts in healthcare: experimental evaluation of contracting based on inputs and outcomes
RCT ID
AEARCTR-0000179
Initial registration date
December 18, 2013

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
December 18, 2013, 7:59 PM EST

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Last updated
July 07, 2016, 8:41 AM EDT

Last updated is the most recent time when changes to the trial's registration were published.

Locations

Region

Primary Investigator

Affiliation
Duke University

Other Primary Investigator(s)

PI Affiliation
Stanford University

Additional Trial Information

Status
Completed
Start date
2013-02-01
End date
2014-06-30
Secondary IDs
ClinicalTrials: NCT01480544
Abstract
Despite recent increases in institutional deliveries in India, birth outcomes have been slow to improve. One likely explanation is low quality medical care, which is common in many parts of India. Low quality medical care in India cannot simply be attributed to insufficient medical knowledge among providers. Instead there is evidence that, even among knowledgeable clinicians, provider effort is very low – suggesting poor alignment between clinician incentives and patient health.

To address low quality medical care directly, we are conducting a policy experiment in Karnataka to evaluate the effectiveness of financial incentives to maternity care providers for (a) the clinical quality of services (e.g., assessing the mother’s blood pressure on arrival during labor) provided to women from their patient lists and catchment areas, and (b) rates of adverse maternal and neonatal health outcomes (e.g., rates of post-partum hemorrhage) among women from their patient lists and catchment areas. Performance bonuses for clinical quality hold some promise for better aligning physician incentives with patient needs. Moreover, directly rewarding lower rates of adverse maternal and neonatal health outcomes flexibly identifies a socially desirable outcome without rigidly prescribing how it should be achieved – allowing local providers to use their local knowledge of what health improvement strategies are likely to work best.
External Link(s)

Registration Citation

Citation
, and Manoj Mohanan. 2016. "Performance based contracts in healthcare: experimental evaluation of contracting based on inputs and outcomes." AEA RCT Registry. July 07. https://doi.org/10.1257/rct.179
Former Citation
, and Manoj Mohanan. 2016. "Performance based contracts in healthcare: experimental evaluation of contracting based on inputs and outcomes." AEA RCT Registry. July 07. https://www.socialscienceregistry.org/trials/179/history/9312
Sponsors & Partners

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Experimental Details

Interventions

Intervention(s)
Intervention Start Date
2013-02-01
Intervention End Date
2014-06-30

Primary Outcomes

Primary Outcomes (end points)
quality of obstetric care, maternal and neonatal health outcomes
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
Providers are randomly assigned to one of two treatment groups, where incentive payments are based on health care quality or health outcomes, or to a control group.
Experimental Design Details
Randomization Method
by computer
Randomization Unit
health care provider
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
164 health care providers
Sample size: planned number of observations
15,000 women
Sample size (or number of clusters) by treatment arms
47 providers in inputs group (incentive payments for quality of care)
60 providers in outputs group (incentive payments for health outcomes)
57 providers in control group
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
Duke University Health System Institutional Review Board
IRB Approval Date
2011-06-02
IRB Approval Number
Pro00031046
Analysis Plan

Analysis Plan Documents

Appendix to Analysis Plan - Calculation and Measurement of Inputs and Outputs

MD5: 3c34b352f32431b7e2326a07b4322fe4

SHA1: bb4a2602c4ae7b619a27bd31f7e99bf9a0ce88b7

Uploaded At: July 07, 2016

IMATCHINE+Pre-analysis+Plan+12-20-2013.pdf

MD5: 021c43b9878bfd2e9fc64964759df64a

SHA1: d5cd49aeaec57d3cbcab9a0d8f631ccb3cd0cb40

Uploaded At: December 20, 2013

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials