Cancer Screening: Provider Incentives — Cervical Cancer
Findings and Recommendations
The Community Preventive Services Task Force (CPSTF) finds insufficient evidence to determine the effectiveness of provider incentives in increasing screening for cervical cancers. Evidence is insufficient because of a small magnitude of effect across studies and because data from health care systems that include provider incentives as part of their strategies for administration and provider compensation have not been published.
The full CPSTF Finding and Rationale Statement and supporting documents for Cancer Screening: Provider Incentives — Cervical Cancer are available in The Community Guide Collection on CDC Stacks.
Intervention
Provider incentives are direct or indirect rewards intended to motivate providers to perform cancer screening or make appropriate referral for their patients to receive these services. Rewards are often monetary, but can also include nonmonetary incentives (e.g., continuing medical education credit). Because some form of assessment is needed to determine whether providers receive rewards, an assessment component may be included in the intervention.
About The Systematic Review
The CPSTF finding is based on evidence from a Community Guide systematic review published in 2008 (Sabatino, et al., search period through September 2004) combined with more recent evidence (search period 2004 – October 2008).
The effectiveness of provider-directed interventions was determined by considering evidence across all three cancer screening sites combined, as long as there were not differences in effectiveness by screening test. This was done because provider behavior was thought to be less influenced than client behavior by the nature of screening tests.
Study Characteristics
- Physician settings ranged from large, multi-specialty organizations to individual practice associations or physician practices.
- Included studies reported completed screenings or recommended or offered screenings.
- Studies that reported completed screenings used medical records or performance reports to measure outcomes.
- Incentives varied across studies.
Summary of Results
The review included five studies that assessed intervention effectiveness for breast, cervical, and colorectal cancers.
- Screening completion for breast, cervical or colorectal cancer: median increase of 1.7 percentage points (interquartile interval: 0.1 to 3.6 percentage points; 7 study arms)
- Completed cervical cancer screening by Pap test: estimated effects ranged from a 3.6 to 8.0 percentage point increase (2 study arms)
Summary of Economic Evidence
An economic review of this intervention was not conducted because the CPSTF did not have enough information to determine if the intervention works.
Applicability
Applicability of this intervention across different settings and populations was not assessed because the CPSTF did not have enough information to determine if the intervention works.
Evidence Gaps
The following outlines evidence gaps for reviews of provider incentives to increase breast, cervical, and colorectal cancer screening.
The effectiveness of provider incentives in increasing colorectal, breast, and cervical cancer screening has not been established. Despite great interest in and use of provider incentives in many organized health systems (e.g., pay-for-performance models), relatively little published scientific information is available to assess the effectiveness of incentives in increasing screening for breast, cervical, and colorectal cancers. Several research questions remain.
- Are provider incentives effective in increasing screening for colorectal, breast, and cervical cancers?
- Do provider incentives incrementally increase the effectiveness of provider assessment and feedback interventions?
- What are the most cost-effective approaches to reward cancer screening performance and/or referral by practitioners?
- Do these interventions result in other positive or negative changes in health behavior or use of healthcare services?
- What are the incremental effects of adding intervention components to other interventions?
- What influence do newer methods of communication (e.g., the Internet, e-mail, social media, automated interactive voice response, texting) have on intervention effectiveness?
- What is the influence of health system factors on intervention effectiveness?
- Are interventions effective for promoting colorectal cancer screening with methods other than FOBT?
- Are interventions to promote colorectal cancer screening equally effective when specific to one type of test as they are when addressing colorectal cancer screening more generally?
Implementation Considerations and Resources
The CPSTF did not have enough evidence to determine whether the intervention is or is not effective. This does not mean that the intervention does not work, but rather that additional research is needed to determine whether or not the intervention is effective.