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Using health aides to build patient rosters in primary care clinics in Misiones province, Argentina: impact of information technology with results-based financing on appropriateness of care
Last registered on December 20, 2017

Pre-Trial

Trial Information
General Information
Title
Using health aides to build patient rosters in primary care clinics in Misiones province, Argentina: impact of information technology with results-based financing on appropriateness of care
RCT ID
AEARCTR-0002641
Initial registration date
December 14, 2017
Last updated
December 20, 2017 10:20 AM EST
Location(s)
Region
Primary Investigator
Affiliation
World Bank
Other Primary Investigator(s)
PI Affiliation
World Bank
Additional Trial Information
Status
In development
Start date
2018-01-01
End date
2020-06-30
Secondary IDs
Abstract
The main objective of this study is to evaluate the impact of providing a mobile application (app) to community health aides in the province of Misiones, to be used during home visits (health rounds). We will evaluate the impact on the identification of at-risk population, the comprehensiveness of care and the health status of the of the population. The application - to be installed on tablets - will allow the community health workers to register their reference population and their epidemiological profile, locate it on a digital map, monitor the use of health services, and identify and report follow-up needs to the primary health care center (CAPS). The study also aims to evaluate whether having this application in home visits achieves better results when it is implemented together with an incentive payment to CAPS. That is, the CAPS would receive an additional payment for each person identified during the home visits and registered by the application, provided that said person receives (or has received) at least one health benefit among those selected for this study in a given period.
The impact identification strategy is based on the random assignment of the public CAPS of Misiones to two treatment groups and one control group. The sample includes 120 CAPS, which provide approximately 85% of public services to the population of the province that has only public health coverage. 40 CAPS will be assigned to treatment group T1 that will receive the application and a payment to CAPS for identifying, registering and serving their dependent population; another 40 CAPS will be assigned to the treatment group T2 that will receive the application (without additional payment); and the 40 remaining CAPS will be assigned to the control group. The main source of quantitative data to measure the impact of interventions will be the provincial health information systems.
External Link(s)
Registration Citation
Citation
Giovagnoli, Paula and Christel Vermeersch. 2017. "Using health aides to build patient rosters in primary care clinics in Misiones province, Argentina: impact of information technology with results-based financing on appropriateness of care." AEA RCT Registry. December 20. https://doi.org/10.1257/rct.2641-2.0.
Former Citation
Giovagnoli, Paula, Christel Vermeersch and Christel Vermeersch. 2017. "Using health aides to build patient rosters in primary care clinics in Misiones province, Argentina: impact of information technology with results-based financing on appropriateness of care." AEA RCT Registry. December 20. http://www.socialscienceregistry.org/trials/2641/history/24256.
Sponsors & Partners

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Experimental Details
Interventions
Intervention(s)
The proposed intervention will be carried out in a group of primary health care centers (CAPS) in Misiones that currently have an agreement with the SUMAR Program and that currently work with community health aides who carry out extramural activities.
The intervention aims to strengthen the link between the CAPS health team and the population in its geographical area of responsibility, through two channels:
First, the health aides will be equipped with a tablet and an application that that will allow it to register and access more accurate and comprehensive information on the socio-medical situation of their population.
Second, a subgroup of CAPS that receives the tablets and application, will receive an additional performance-based payment for (a) the identification and geo-referencing of their population (b) the provision of appropriate promotion and prevention services to this population. CAPS will be able to use the additional revenue to purchase goods to improve the working conditions of the health aides.
Intervention Start Date
2018-07-01
Intervention End Date
2019-12-31
Primary Outcomes
Primary Outcomes (end points)
Percentage of pregnant women who received adequate care package
Primary Outcomes (explanation)
The adequacy of the care package is defined by checking the services actually received against a list of services recommended in the clinical practice guidelines.
Secondary Outcomes
Secondary Outcomes (end points)
Outcome variables: Neonatal results of population (weight, apgar score); Control of hypertension in adults; Number of preventive services to children, adolescents and adults; Percentage of SUMAR beneficiaries that receive at least one preventive service, separately for children, adolescents and adults; Percentage of SUMAR beneficiaries that receive minimal, basic and complete packages of essential services, as defined by program rules; performance-based disbursements to CAPS.Process variables: number and proportion of health aides who use the application to identify their population; number of appointments made for their population through the application, number of messages transmitted from the health aides to the health centers through the application
Secondary Outcomes (explanation)
Experimental Design
Experimental Design
The identification strategy is based on the random assignment of public health primary care centers to two treatment groups and one control group. The sample includes 120 center. A first set of 40 centers will be assigned to treatment group T1 that will receive both the application and a payment to identify, register and provide care for its population; another 40 centers will be assigned to treatment group T2 that will receive the application; and the 40 remaining centers will be assigned to the control group.
Experimental Design Details
The impact identification strategy is based on the random assignment of the public CAPS of Misiones to two treatment groups and one control group. The sample includes 120 CAPS, which provide approximately 85% of public services to the population of the province that has only public health coverage. 40 CAPS will be assigned to treatment group T1 that will receive the application and a payment to CAPS for identifying, registering and serving their dependent population; another 40 CAPS will be assigned to the treatment group T2 that will receive the application (without additional payment); and the 40 remaining CAPS will be assigned to the control group. The main source of quantitative data to measure the impact of interventions will be the provincial health information systems.
Randomization Method
Public lottery using lotto-type device
Randomization Unit
Health center (CAPS)
Was the treatment clustered?
Yes
Experiment Characteristics
Sample size: planned number of clusters
120 health centers (CAPS)
Sample size: planned number of observations
3000 pregnant women per year
Sample size (or number of clusters) by treatment arms
40 health centers treatment 1 (application + Pay for performance); 40 centers treatment 2 (application only); 40 centers control
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
Percentage of pregnant women who receive adequate package of care. Baseline: 52%, Minimum detectable effect is 10 pp for a significance level of 5% and power of 0.8.
IRB
INSTITUTIONAL REVIEW BOARDS (IRBs)
IRB Name
IRB Approval Date
IRB Approval Number
Post-Trial
Post Trial Information
Study Withdrawal
Intervention
Is the intervention completed?
No
Is 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