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 15, 2017

Pre-Trial

General Information

Title

RCT ID

AEARCTR-0002641

Initial registration date

December 14, 2017

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 15, 2017, 5:18 PM EST

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

Locations

Country

Argentina

Region

Misiones

Primary Investigator

Name

Christel Vermeersch

Affiliation

World Bank

Contact Primary Investigator

Other Primary Investigator(s)

PI Name

Paula Giovagnoli

PI Affiliation

World Bank

Contact Investigator

Additional Trial Information

Status

In development

Start date

2018-01-01

End date

2020-06-30

Keywords

Health

Additional Keywords

primary health care (D011320), community health aides (D003150), diffusion of innovation (D004059), medical informatics application (D008491), healthcare financing (D061889)

JEL code(s)

Secondary IDs

Abstract

The objective of this study is to evaluate the health impact of introducing a technological innovation that consists of equipping community health aides with an application (on tablets) that allows them to register and identify the population in their geographical area of responsibility, visualize them on a digital map, monitor their health needs as well as their use of health services. The study also aims to evaluate whether making the application available achieves better results when accompanied by an incentive to the health center. That is, the center would receive an additional payment for each person identified and registered through the application, as long as said person receives a preventive health service within a determined time period.
The identification strategy is based on the random assignment of public primary health care centers to two treatment groups and one control group. The sample includes 120 centers. 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. The main source of quantitative data to measure the impact of the two interventions will be medical record information from the respective 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 15. https://doi.org/10.1257/rct.2641-1.0

Former Citation

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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

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 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 centers, which represent approximately 85% of the health services provided by the public system to the population of the province that does not have alternative health insurance coverage. 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.
The 120 centers are the largest centers in the province and represent approximately 85% of the health services provided by the public system to the population of the province that does not have alternative health insurance coverage.

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.

Supporting Documents and Materials

IRB