Financial incentives and physician commitment to guideline-recommended hypertension management.

Objectives: To examine the impact of financial incentives on physician goal commitment to guideline-recommended hypertension care.

Study Design: Clinic-level cluster-randomized trial with 4 arms: individual, group, or combined incentives, and control.

Methods: A total of 83 full-time primary care physicians at 12 Veterans Affairs medical centers completed web-based surveys measuring their goal commitment to guideline-recommended hypertension care every 4 months and telephone interviews at months 8 and 16. Intervention arm participants received performance-based incentives every 4 months for 5 periods. All participants received guideline education at baseline and audit and feedback every 4 months.

Results: Physician goal commitment did not vary over time or across arms. Participants reported patient nonadherence was a perceived barrier and consistent follow-up was a perceived facilitator to successful hypertension care, suggesting that providers may perceive hypertension management as more of a patient responsibility (external locus of control).

Conclusions: Financial incentives may constitute an insufficiently strong intervention to influence goal commitment when providers attribute performance to external forces beyond their control.