In Espoo and Vantaa primary health care before the research date in 2005, the level of recording of diagnoses in electronic patient information systems was less than 50 per cent, as in the rest of Finland. On the basis of the research data at the time the City of Espoo’s primary health care decided to improve the level of diagnosis through financial incentives. In Vantaa, a little later in 2008, an information system reminder was introduced for the same reason. A significantly increased rate of recorded diagnoses was assessed as necessary when planning operations and in managing primary health care resources and assessing the effectiveness of operations.
The Espoo and Vantaa Primary Health Care Studies (I and II) assessed whether team incentives and information system reminders affected the level of recording of general practitioner’s diagnoses in primary care. The aim was to monitor and compare not only the effects of interventions, but also the duration of interventions and to examine the quality of diagnoses. The purpose of these studies was to examine whether electronic reminders introduced into the patient records system, and improved by varying degrees of feedback discussions, increased the registration rate for diagnosis of diseases after GP appointments. The aim was also to assess how the impact of the reminders differed from the financial group bonus, which had proved to be an effective method of increasing the recording of diagnoses based on previous studies (I and II).
One of the aims of Study III was to examine the extent of the impact of Espoo’s group bonuses on the improvement in the level of recording of diagnoses in the patient records system and to examine whether intervention caused differences between treatment teams. At the same time efforts were made to assess whether the reward support had produced data reflected in the distribution of diagnoses in real clinical life in primary care and whether the diagnoses provided potentially valid information on public health.
Similarly, the purpose of the Vantaa Research Plan (IV) was to study the impact of electronic reminders in the Patient Information System on the number of diagnoses of illness during GP visits and regarding which diagnoses had been recorded. The aim of this research setting, too, was to obtain information on whether the electronic reminder intervention had produced information reflecting the distribution of diagnoses in real clinical life in primary health care, while providing current public health information.
According to this research, financial group bonuses can provide a faster method than electronic reminders in the development of service activities designed to improve primary care clinical practices. However, the expected effects of financial incentives may slowly weaken if these incentives are completely stopped. Based on this study, economic incentives did not appear to have increased the recording of chronic diseases such as diabetes.
Electronic reminders were effective in changing the behavior in general practices. Combined with varying degrees of development discussions, reminders led to the same level of diagnosis in recording as group bonuses.
The electronic reminder appears to be a significantly more cost-effective individual contribution than the annual financial incentive paid to staff. Electronic reminders can be considered to produce more sustainable results than financial rewards when trying to influence behaviour in general practices in primary care. Both forms of intervention appear to provide valuable public health information for primary care administration.
The subject of the research is still current in the search for ways to develop higher-quality treatments and processes in primary health care. The new treatment model must take into account the importance of the entire care team and broader support services in the activities of healthcare systems.
The doctoral dissertation of M.D. Tuomo Lehtovuori in the field of medicine titled Ryhmätulospalkkauksen ja tietojärjestelmämuistutusten vaikutus diagnoosien merkintään Espoon ja Vantaan perusterveydenhuollossa will be publicly examined at the Faculty of Medicine and Health Technology of Tampere University at 12 o'clock on Friday 10 December, 2021. Docent Simo Kokko from University of Eastern Finland will be the opponent while Professor Markku Sumanen will act as the custos.
The event can be followed via remote connection
According to the latest coronavirus policy, anyone coming to a dissertation defence from outside the university community must present their COVID-19 Certificate and their ID upon arrival. University employees must present their staff ID and students their student ID.
The dissertation is available online at
http://urn.fi/URN:ISBN:978-952-03-2170-3
Photo: Pirjo Lehtovuori