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Financial Incentives, Quality Improvement Programs, and the Adoption of Clinical Information Technology

Robinson, James C. PhD*; Casalino, Lawrence P. MD, PhD; Gillies, Robin R. PhD*; Rittenhouse, Diane R. MD; Shortell, Stephen S. PhD*; Fernandes-Taylor, Sara BA*

doi: 10.1097/MLR.0b013e31818d7746
Original Article

Objective: Physician use of clinical information technology (CIT) is important for the management of chronic illness, but has lagged behind expectations. We studied the role of health insurers' financial incentives (including pay-for-performance) and quality improvement initiatives in accelerating adoption of CIT in large physician practices.

Methods: National survey of all medical groups and independent practice association (IPA) physician organizations with 20 or more physicians in the United States in 2006 to 2007. The response rate was 60.3%. Use of 19 CIT capabilities was measured. Multivariate statistical analysis of financial and organizational factors associated with adoption and use of CIT.

Results: Use of information technology varied across physician organizations, including electronic access to laboratory test results (medical groups, 49.3%; IPAs, 19.6%), alerts for potential drug interactions (medical groups, 33.9%; IPAs, 9.5%), electronic drug prescribing (medical groups, 41.9%; IPAs, 25.1%), and physician use of e-mail with patients (medical groups, 34.2%; IPAs, 29.1%). Adoption of CIT was stronger for physician organizations evaluated by external entities for pay-for-performance and public reporting purposes (P = 0.042) and for those participating in quality improvement initiatives (P < 0.001).

Discussion: External incentives and participation in quality improvement initiatives are associated with greater use of CIT by large physician practices.

From the *University of California, School of Public Health, Berkeley, California; †Department of Public Health, Weill Cornell Medical College, New York, New York; and ‡Department of Family and Community Medicine, University of California, San Francisco, California.

Supported by grants from the Robert Wood Johnson Foundation, the Commonwealth Fund, and the California Healthcare Foundation.

Reprints: James C. Robinson, PhD, University of California, School of Public Health, Berkeley, CA 94720-7360. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.