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Effect of Modest Pay-for-Performance Financial Incentive on Time-to-Discharge Summary Dictation Among Medical Residents

Wolk, Adam MD; Wang, Erwin MHA; Horak, Bernard PhD; Cloonan, Patricia PhD; Adams, Michael MD; Moore, Eileen MD; Jaipaul, Chitra Komal MD; Brown, Gabrielle MHSA; Dasgupta, Dabanjan BS; Deluca, Danielle BS; Grossman, Mila BS

doi: 10.1097/QMH.0000000000000008
Original Articles

Objective: Evaluate the effect of a modest financial incentive on time-to-discharge summary dictation among medicine residents.

Background: Pay-for-performance incentives are used in a number of health care settings. Studies are lacking on their use with medical residents and other trainees. Timely completion of discharge summaries is necessary for effective follow-up after hospitalization, and residents perform the majority of discharge summary dictations in academic medical centers.

Methods: Medicine residents with the lowest average discharge-to-dictation time during their 1-month inpatient medicine ward rotation were rewarded with a $50 gift card. Discharge data were captured using an autopopulating electronic database.

Results: The average discharge-to-dictation time was reduced from 7.44 to 1.84 days, representing a 75.3% decrease. Almost 90% of discharge summary dictations were performed on the day of discharge.

Conclusion: A modest financial incentive resulted in a marked improvement in the time-to-discharge summary dictation by medicine residents. Pay-for-performance programs may be an effective strategy for improving the quality and efficiency of patient care in academic medical centers.

Department of Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia (Drs Wolk, Adams, Moore, and Jaipaul); Georgetown University School of Medicine, Washington, District of Columbia (Mr Wang); School of Nursing and Health Studies, Georgetown University, Washington, District of Columbia (Drs Horak and Cloonan and Ms Brown, Deluca, and Grossman); and University of Virginia, Charlottesville (Mr Dasgupta).

Correspondence: Adam Wolk, MD, Department of Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (

The authors thank Bruce Luxon, MD, Department of Medicine, MedStar Georgetown University Hospital, Georgetown University, Washington, District of Columbia.

The authors declare no conflicts of interest.

© 2013Wolters Kluwer Health | Lippincott Williams & Wilkins