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To the Editor In the trial reported by Dr Petersen and colleagues,1 financial incentives to physicians and practice teams were found to exert an “unexpectedly” impermanent effect on an outcome measure that combined blood pressure control with appropriate clinical response to uncontrolled blood pressure. In their study protocol,2 Petersen et al indicated the combined measure would be used partly as a precaution against “gaming” by physicians of a purely process of care measure. In making this argument, the authors appeared to presume that blood pressure measures are themselves immune to manipulation. Were this presumption proven false, this trial’s dependence on endogenously measured blood pressures would compromise its internal validity.
Norris DC. Financial Incentives to Control Hypertension in Patients. JAMA. 2014;311(3):303. doi:10.1001/jama.2013.284312