Design of Pay-for-Performance Programs Affects Clinical Staff Perceptions of HPV Vaccine Incentives: Evidence from a US Survey.

This study reports how 3 design features (size of incentive, who is responsible, and target goal) affect clinical staff perceptions of pay-for-performance (P4P) for HPV vaccination. We conducted a national survey of clinical staff in 2022 (N = 2527; response rate = 57%). Respondents worked in pediatrics, family medicine, or general medicine specialties in the United States and had a role in HPV vaccination for children ages 9 through 12 years. Respondents were randomized to 1 of 8 P4P scenarios representing 3 design features with 2 levels each. We used ordered logistic regression to model respondents' agreement with each of 11 statements about the P4P scenario. Statements represented domains of the Theory of Planned Behavior (attitudes, perceived behavioral control, and norms) plus 2 equity items. Relative to a $1000 incentive, a $5000 incentive was associated with favorable perceptions in 8/11 items: 5/5 attitude items and 1/2 items for each of control, norms, and equity. Incentives based on an individual provider's patients, rather than the entire clinic's patients, were associated with more agreement for 1 attitude item and 1 perceived behavioral control item. Relative to an absolute goal of 80%, a goal of 5% relative increase in HPV vaccination rates was associated with favorable perceptions for 3/5 attitude items and 1 equity item. Clinical staff perceptions of P4P for HPV vaccination were more favorable the larger the size of the incentive, when it was focused on a provider's own patients, and when the goal was a relative, rather than absolute, target.