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Effect of modest pay-for-performance financial incentive on time-to-discharge summary dictation among medical
Adam Wolk1, Erwin Wang, Bernard Horak
1Department 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).
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.
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