Pilot demonstration for physician compensation incentives to improve diagnostic specificity in clinical documentation

Omissions in clinical documentation hinder diagnosis by obscuring important information and delaying communication among clinicians. Additionally, carefully implemented incentives can improve health care processes such as clinical documentation. Therefore, we created a pilot using $20,000 in compensation incentives to improve free text documentation for six common outpatient diagnoses (cerebrovascular accidents, chronic kidney disease, congestive heart failure, deep vein thrombosis and pulmonary embolism, chronic obstructive pulmonary disease, and smoking) in an urban health system.

For each diagnosis, we asked clinicians to document 2-3 pre-specified clinically significant, evidence-based details that influence diagnosis or management. We compared baseline documentation (Aug 15th-Sep 25th, 2022) with an incentivized period (Sep 26th-Dec 16th, 2022) using an unadjusted signed rank test and an adjusted generalized linear mixed model. All 32 eligible physicians and advanced practice providers participated.

Among 693 baseline and 1,494 intervention opportunities when a diagnosis was assessed, documentation that included all clinically significant details improved from mean 32.2 % (SD 20.7) to mean 47.1 % (SD 23.6; p=0.01) and in our adjusted analysis from 35.6 to 48.2 % (p<0.001). Seven participants' documentation improved by ≥1.6 diagnoses per week.

In conclusion, compensation incentives improved free text documentation of clinically significant information to improve the diagnostic process.