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Reisinger HS, Brackett RH, Buzza CD, Páez MBW, Gourley R, Weg MWV, Christensen AJ, Kaboli PJ. "All the money in the world …" patient perspectives regarding the influence of financial incentives. Health Serv Res 2011; 46:1986-2004. [PMID: 21689098 DOI: 10.1111/j.1475-6773.2011.01287.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To analyze patient perspectives of the use of financial incentives in a hypertension intervention. Study Setting. Twelve Veterans Affairs primary care clinics over a 9-month period. STUDY DESIGN Qualitative semistructured interviews conducted with 54 hypertensive veterans participating in an intervention to promote guideline-consistent therapy. Intervention components included an intervention letter requesting patients talk with their providers, an offer of U.S.$20 to bring in the letter to their provider, and a health educator phone call. DATA COLLECTION METHODS Semistructured interviews were conducted. Transcripts were coded for thematic content. The financial incentive theme was then subcoded for more detailed analysis. PRINCIPLE FINDINGS Most participants (n=48; 88.9 percent) stated the incentive had (or would have) no effect on their decision to initiate a discussion with their provider. Some participants articulated reservations about the effectiveness and/or appropriateness of financial incentives in health care decisions; however, a few expressed the opinion that there may be some potential benefits to the use of financial incentives if they encourage patients to be active in their health care. CONCLUSION The findings of this study raise questions about the appropriateness and unintended consequences of employing patient-directed financial incentives in health care settings.
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Affiliation(s)
- Heather Schacht Reisinger
- The Center for Comprehensive Access and Delivery Research and Evaluation-CADRE, the Iowa City VA Medical Center, Iowa City, IA, USA.
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Delivering alcohol screening and alcohol brief interventions within general dental practice: rationale and overview of the evidence. Br Dent J 2011; 210:E15. [PMID: 21566582 DOI: 10.1038/sj.bdj.2011.363] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2010] [Indexed: 11/09/2022]
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Videau Y, Batifoulier P, Arrighi Y, Gadreau M, Ventelou B. [The life cycle of general practitioners' professional motivations: the case of prevention]. Rev Epidemiol Sante Publique 2011; 58:301-11. [PMID: 20864280 DOI: 10.1016/j.respe.2010.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 04/19/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND The analysis of "professional motivations", mainly through the possible crowding-out effects between extrinsic and intrinsic motivations, has become an issue of great concern in the economic literature. This paper aims at applying this topic to the healthcare professions where the proper scaling up of pay-for-performance (P4P) policies by public authorities is at stake. METHODS We used a panel of 528 self-employed general practitioners in the "Provence-Alpes-Côte d'Azur" region in France to provide an interpersonal statistical decomposition between extrinsic and intrinsic motivations with regard to preventive actions. Then, we applied a Tobit model in order to specify the main explicative variables of the share of intrinsic motivations entering into physicians' total motivations. RESULTS The relative share of intrinsic motivations was quite high among physicians paid with fixed fees. We found a significant effect of age on intrinsic motivations describing a U-shaped curve which can be interpreted as being the result of a "life cycle of medical motivations" or a generational effect. CONCLUSION The cross-sectional nature of the data does not allow us to draw any conclusions concerning the predominance of the generational effect or the "life cycle effect" on the evolution of the relative share of physician's intrinsic motivations. Nevertheless, the U-shaped relation between intrinsic motivations and age questions the suitability of using uniformly P4P mechanisms. The generations or age groups of self-employed physicians who seem to be less responsive to extrinsic motivations are more likely to favour the introduction of other types of payment schemes (capitation or salary systems) or regulation tools such as clinical practice guidelines.
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Affiliation(s)
- Y Videau
- Inserm, U912 (SE4S), 13006 Marseille, France.
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Zhao Y, Cui S, Yang J, Wang W, Guo A, Liu Y, Liang W. Basic public health services delivered in an urban community: a qualitative study. Public Health 2011; 125:37-45. [PMID: 21145087 PMCID: PMC7118740 DOI: 10.1016/j.puhe.2010.09.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 08/04/2010] [Accepted: 09/21/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To understand the advancements in and barriers to the implementation of measures to improve basic public health services in an urban Chinese community. STUDY DESIGN A qualitative study based on semi-structured interviews. Interviews were audio-taped, transcribed and analysed using thematic content analysis. METHODS In-depth interviews were undertaken with the directors of the management centres for community health services in 15 of the 18 districts in Beijing from December 2008 to February 2009. Content analysis of the data was completed in May 2009. RESULTS Fifteen types of free basic public health services had been delivered in Beijing. Some were supplied at a low level. An average of £2.38 per person per year was provided for inhabitants since 2008, but demand for funding far exceeded monies available. Teams consisting of general practitioners, community nurses and public health specialists delivered these services. The number of practitioners and their low levels of skill were insufficient to provide adequate services for community residents. Respondents gave recommendations of how to resolve the above problems. CONCLUSIONS In order to improve the delivery of basic public health services, it is necessary for Beijing Municipal Government to supply clear and detailed protocols, increase funding and increase the number of skilled practitioners in the community health services.
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Affiliation(s)
- Y Zhao
- School of Public Health and Family Medicine, Capital Medical University, Beijing 100069, China
| | - S Cui
- School of Public Health and Family Medicine, Capital Medical University, Beijing 100069, China
| | - J Yang
- National Institute of Hospital Administration, Ministry of Health of the People's Republic of China, Beijing 100083, China
| | - W Wang
- School of Public Health and Family Medicine, Capital Medical University, Beijing 100069, China
| | - A Guo
- School of Public Health and Family Medicine, Capital Medical University, Beijing 100069, China
| | - Y Liu
- School of Public Health and Family Medicine, Capital Medical University, Beijing 100069, China
| | - W Liang
- Office of Health Emergency (Centre for Public Health Emergency), Ministry of Health of the People's Republic of China, No.1, Xi Zhi Men Wai Nan Road, Beijing 100044, China.
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Van Herck P, De Smedt D, Annemans L, Remmen R, Rosenthal MB, Sermeus W. Systematic review: Effects, design choices, and context of pay-for-performance in health care. BMC Health Serv Res 2010; 10:247. [PMID: 20731816 PMCID: PMC2936378 DOI: 10.1186/1472-6963-10-247] [Citation(s) in RCA: 302] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 08/23/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. Substantial heterogeneity exists in the development and implementation of P4P in health care and its effects. This paper summarizes evidence, obtained from studies published between January 1990 and July 2009, concerning P4P effects, as well as evidence on the impact of design choices and contextual mediators on these effects. Effect domains include clinical effectiveness, access and equity, coordination and continuity, patient-centeredness, and cost-effectiveness. METHODS The systematic review made use of electronic database searching, reference screening, forward citation tracking and expert consultation. The following databases were searched: Cochrane Library, EconLit, Embase, Medline, PsychINFO, and Web of Science. Studies that evaluate P4P effects in primary care or acute hospital care medicine were included. Papers concerning other target groups or settings, having no empirical evaluation design or not complying with the P4P definition were excluded. According to study design nine validated quality appraisal tools and reporting statements were applied. Data were extracted and summarized into evidence tables independently by two reviewers. RESULTS One hundred twenty-eight evaluation studies provide a large body of evidence -to be interpreted with caution- concerning the effects of P4P on clinical effectiveness and equity of care. However, less evidence on the impact on coordination, continuity, patient-centeredness and cost-effectiveness was found. P4P effects can be judged to be encouraging or disappointing, depending on the primary mission of the P4P program: supporting minimal quality standards and/or boosting quality improvement. Moreover, the effects of P4P interventions varied according to design choices and characteristics of the context in which it was introduced.Future P4P programs should (1) select and define P4P targets on the basis of baseline room for improvement, (2) make use of process and (intermediary) outcome indicators as target measures, (3) involve stakeholders and communicate information about the programs thoroughly and directly, (4) implement a uniform P4P design across payers, (5) focus on both quality improvement and achievement, and (6) distribute incentives to the individual and/or team level. CONCLUSIONS P4P programs result in the full spectrum of possible effects for specific targets, from absent or negligible to strongly beneficial. Based on the evidence the review has provided further indications on how effect findings are likely to relate to P4P design choices and context. The provided best practice hypotheses should be tested in future research.
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Affiliation(s)
- Pieter Van Herck
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
| | - Delphine De Smedt
- Department of Public Health, Ghent University, De Pintelaan 185 Blok A-2, 9000 Gent, Belgium
| | - Lieven Annemans
- Department of Public Health, Ghent University, De Pintelaan 185 Blok A-2, 9000 Gent, Belgium
| | - Roy Remmen
- Department of General Practice, University Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Meredith B Rosenthal
- Harvard School of Public Health, Health Policy and Management, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Walter Sermeus
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
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Ranson MK, Chopra M, Atkins S, Dal Poz MR, Bennett S. Priorities for research into human resources for health in low- and middle-income countries. Bull World Health Organ 2010; 88:435-43. [PMID: 20539857 PMCID: PMC2878144 DOI: 10.2471/blt.09.066290] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 10/06/2009] [Accepted: 10/22/2009] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To identify the human resources for health (HRH) policy concerns and research priorities of key stakeholders in low- and middle-income countries; to assess the extent to which existing HRH research addresses these concerns and priorities; and to develop a prioritized list of core research questions requiring immediate attention to facilitate policy development and implementation. METHODS The study involved interviews with key informants, including health policy-makers, researchers and community and civil society representatives, in 24 low- and middle-income countries in four regions, a literature search for relevant reviews of research completed to date, and the assessment of interview and literature search findings at a consultative multinational workshop, during which research questions were prioritized. FINDINGS Twenty-one research questions emerged from the key informant interviews, many of which had received little or no attention in the reviewed literature. The questions ranked as most important at the consultative workshop were: (i) To what extent do incentives work in attracting and retaining qualified health workers in underserviced areas? (ii) What is the impact of dual practice and multiple employment? and (iii) How can incentives be used to optimize efficiency and the quality of health care? CONCLUSION There was a clear consensus about the type of HRH policy problems faced by different countries and the nature of evidence needed to tackle them. Coordinated action to support and implement research into the highest priority questions identified here could have a major impact on health worker policies and, ultimately, on the health of the poor.
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Affiliation(s)
- Michael Kent Ranson
- Alliance for Health Policy and Systems Research, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland.
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Establishing health systems financing research priorities in developing countries using a participatory methodology. Soc Sci Med 2010; 70:1933-1942. [DOI: 10.1016/j.socscimed.2010.01.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 01/13/2010] [Accepted: 01/24/2010] [Indexed: 11/24/2022]
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Abstract
Brief intervention (BI) is intended as an early intervention for non-treatment-seeking, non-alcohol-dependent, hazardous and harmful drinkers. This text provides a brief summary of key BI research findings from the last three decades and discusses a number of knowledge gaps that need to be addressed. Five areas are described: patient intervention efficacy and effectiveness; barriers to BI implementation by health professionals; individual-level factors that impact on BI implementation; organization-level factors that impact on BI implementation; and society-level factors that impact on BI implementation. BI research has focused largely upon the individual patient and health professional levels, with the main focus upon primary health care research, and studies are lacking in other settings. However, research must, to a larger degree, take into account the organizational and wider context in which BI occurs, as well as interaction between factors at different levels, in order to advance the understanding of how wider implementation of BI can be achieved in various settings and how different population groups can be reached. It is also important to expand BI research beyond its current parameters to investigate more ambitious long-term educational programmes and new organizational models. More widespread implementation of BI will require many different interventions (efforts, actions, initiatives, etc.) at different interlinked levels, from implementation interventions targeting individual health professionals' knowledge, skills, attitudes and behaviours concerning alcohol issues, BI and behaviour change counselling to efforts at the organizational and societal levels that influence the conditions for delivering BI as part of routine health care.
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Affiliation(s)
- Per Nilsen
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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Parkinson MD, Ahluwalia JS, Shih DC, Barry MA, Schechter CB. Advancing Aspirin Utilization: A Review of Clinical and Systems-Based Interventions. Am J Med Qual 2010; 25:351-8. [DOI: 10.1177/1062860610366032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - David C. Shih
- American College of Preventive Medicine, Pittsburgh, PA
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Bilardi JE, Fairley CK, Temple-Smith MJ, Pirotta MV, McNamee KM, Bourke S, Gurrin LC, Hellard M, Sanci LA, Wills MJ, Walker J, Chen MY, Hocking JS. Incentive payments to general practitioners aimed at increasing opportunistic testing of young women for chlamydia: a pilot cluster randomised controlled trial. BMC Public Health 2010; 10:70. [PMID: 20158918 PMCID: PMC2841675 DOI: 10.1186/1471-2458-10-70] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 02/17/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Financial incentives have been used for many years internationally to improve quality of care in general practice. The aim of this pilot study was to determine if offering general practitioners (GP) a small incentive payment per test would increase chlamydia testing in women aged 16 to 24 years, attending general practice. METHODS General practice clinics (n = 12) across Victoria, Australia, were cluster randomized to receive either a $AUD5 payment per chlamydia test or no payment for testing 16 to 24 year old women for chlamydia. Data were collected on the number of chlamydia tests and patient consultations undertaken by each GP over two time periods: 12 month pre-trial and 6 month trial period. The impact of the intervention was assessed using a mixed effects logistic regression model, accommodating for clustering at GP level. RESULTS Testing increased from 6.2% (95% CI: 4.2, 8.4) to 8.8% (95% CI: 4.8, 13.0) (p = 0.1) in the control group and from 11.5% (95% CI: 4.6, 18.5) to 13.4% (95% CI: 9.5, 17.5) (p = 0.4) in the intervention group. Overall, the intervention did not result in a significant increase in chlamydia testing in general practice. The odds ratio for an increase in testing in the intervention group compared to the control group was 0.9 (95% CI: 0.6, 1.2). Major barriers to increased chlamydia testing reported by GPs included a lack of time, difficulty in remembering to offer testing and a lack of patient awareness around testing. CONCLUSIONS A small financial incentive alone did not increase chlamydia testing among young women attending general practice. It is possible small incentive payments in conjunction with reminder and feedback systems may be effective, as may higher financial incentive payments. Further research is required to determine if financial incentives can increase testing in Australian general practice, the type and level of financial scheme required and whether incentives needs to be part of a multi-faceted package. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12608000499381.
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Affiliation(s)
- Jade E Bilardi
- Sexual Health Unit, Melbourne School of Population Health, The University of Melbourne, Carlton, Victoria 3053, Australia
| | - Christopher K Fairley
- Sexual Health Unit, Melbourne School of Population Health, The University of Melbourne, Carlton, Victoria 3053, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria 3053, Australia
| | - Meredith J Temple-Smith
- Primary Care Research Unit, Department of General Practice, The University of Melbourne, Carlton, Victoria 3053, Australia
| | - Marie V Pirotta
- Primary Care Research Unit, Department of General Practice, The University of Melbourne, Carlton, Victoria 3053, Australia
| | | | - Siobhan Bourke
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria 3053, Australia
| | - Lyle C Gurrin
- Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, Melbourne School of Population Health, The University of Melbourne, Carlton, Victoria 3053, Australia
| | - Margaret Hellard
- Centre for Population Health, Burnet Institute, Melbourne, Victoria 3004, Australia
| | - Lena A Sanci
- Primary Care Research Unit, Department of General Practice, The University of Melbourne, Carlton, Victoria 3053, Australia
| | - Michelle J Wills
- General Practice Divisions Victoria, 458 Swanston Street, Carlton, Victoria 3053, Australia
| | - Jennifer Walker
- Sexual Health Unit, Melbourne School of Population Health, The University of Melbourne, Carlton, Victoria 3053, Australia
| | - Marcus Y Chen
- Sexual Health Unit, Melbourne School of Population Health, The University of Melbourne, Carlton, Victoria 3053, Australia
- Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria 3053, Australia
| | - Jane S Hocking
- Centre for Women's Health, Gender and Society, Melbourne School of Population Health, The University of Melbourne, Carlton, Victoria 3053, Australia
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Abstract
OBJECTIVE To examine whether the CMS and Premier Inc. Hospital Quality Incentive Demonstration (PHQID), a hospital-based pay-for-performance (P4P) and public quality reporting program, caused participating hospitals (1) to avoid treating minority patients diagnosed with acute myocardial infarction (AMI), heart failure, and pneumonia and (2) to avoid providing coronary artery bypass graft (CABG) to minority patients diagnosed with AMI. DATA SOURCES One hundred percent Medicare inpatient claims, denominator files, and provider of service files from 2000 to 2006. STUDY DESIGN We test for differences in the conditional probability of receiving care at PHQID hospitals for AMI, heart failure, and pneumonia before and after implementation of the PHQID between white and minority patients. We also test for differences in the conditional probability that white and minority patients diagnosed with AMI receive CABG in hospitals participating, and not participating, in the PHQID before and after the implementation of the PHQID. DATA EXTRACTION METHODS Data were obtained from CMS. PRINCIPAL FINDINGS We find little evidence that the PHQID reduced access for minority patients: only "Other Race" beneficiaries had a significant reduction in adjusted admissions to PHQID hospitals in the postperiod, and only for AMI. Only marginally significant ( p<.10) evidence of a reduction in CABG was found, also occurring for Other Race beneficiaries. CONCLUSIONS Despite minimal evidence of minority patient avoidance in the PHQID, monitoring of avoidance should continue for P4P programs.
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Affiliation(s)
- Andrew M Ryan
- Department of Public Health, Weill Medical College-Cornell University, 402 East 67th Street, LA-215, New York, NY 10065, USA.
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Crosson JC, Ohman-Strickland PA, Campbell S, Phillips RL, Roland MO, Kontopantelis E, Bazemore A, Balasubramanian B, Crabtree BF. A comparison of chronic illness care quality in US and UK family medicine practices prior to pay-for-performance initiatives. Fam Pract 2009; 26:510-6. [PMID: 19748914 PMCID: PMC2791043 DOI: 10.1093/fampra/cmp056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Quality and Outcomes Framework (QOF) has contributed to modest improvements in chronic illness care in the UK. US policymakers have proposed similar pay-for-performance (P4P) approaches to improve care. Since previous studies have not compared chronic illness care quality in US and UK primary care practices prior to the QOF, the relative preparedness of practices to respond to P4P incentives is unknown. OBJECTIVE To compare US and UK practices on P4P measures prior to program implementation. METHODS We analysed medical record data collected before QOF implementation from randomly selected patients with diabetes or coronary artery disease (CAD) in 42 UK and 55 US family medicine practices. We compared care processes and intermediate outcomes using hierarchical logistic regression. RESULTS While we found gaps in chronic illness care quality across both samples, variation was lower in UK practices. UK patients were more likely to receive recommended care processes for diabetes [odds ratio (OR), 8.94; 95% confidence interval (CI), 4.26-18.74] and CAD (OR, 9.18; 95% CI, 5.22-16.17) but less likely to achieve intermediate diabetes outcome targets (OR, 0.50; 95% CI, 0.39-0.64). CONCLUSIONS Following National Health Service (NHS) investment in primary care preparedness, but prior to the QOF, UK practices provided more standardized care but did not achieve better intermediate outcomes than a sample of typical US practices. US policymakers should focus on reducing variation in care documentation to ensure the effectiveness of P4P efforts while the NHS should focus on moving from process documentation to better patient outcomes.
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Affiliation(s)
- Jesse C Crosson
- Research Division, Department of Family Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Somerset, NJ 08873, USA.
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Cooke V, Arling G, Lewis T, Abrahamson KA, Mueller C, Edstrom L. Minnesota's Nursing Facility Performance-Based Incentive Payment Program: an innovative model for promoting care quality. THE GERONTOLOGIST 2009; 50:556-63. [PMID: 19846473 DOI: 10.1093/geront/gnp140] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Minnesota's Nursing Facility Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving care quality and efficiency. PIPP moves beyond conventional pay for performance. It seeks to promote implementation of evidence-based practices, encourage innovation and risk taking, foster collaboration and shared learning, and establish a solid case for investing in better quality from the perspective of the state, providers, and consumers. We explain PIPP rationale and design, describe projects and participating facilities, and present findings from interviews with project leaders. DESIGN AND METHODS Provider-initiated projects lasting from 1 to 3 years are selected through a competitive process and are funded for up to 5% of the daily operating per diem rate. Providers are at risk of losing up to 20% of their project funding if they fail to achieve targets on state nursing facility performance measures. RESULTS Minnesota has made a major investment in the PIPP by supporting 45 individual or collaborative projects, representing approximately 160 facilities and annual funding of approximately $18 million. Projects involve a wide range of interventions, such as fall reduction, wound prevention, exercise, improved continence, pain management, resident-centered care and culture change, and transitions to the community. IMPLICATIONS The PIPP can serve as a model for other states seeking to promote nursing facility quality either in combination or in place of conventional pay-for-performance efforts.
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Affiliation(s)
- Valerie Cooke
- Nursing Facility Rates and Policy Division, Department of Human Services, St Paul, Minnesota 55164-0973, USA.
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Ryan AM. Effects of the Premier Hospital Quality Incentive Demonstration on Medicare patient mortality and cost. Health Serv Res 2009; 44:821-42. [PMID: 19674427 PMCID: PMC2699910 DOI: 10.1111/j.1475-6773.2009.00956.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To evaluate the effects of the Premier Inc. and Centers for Medicare and Medicaid Services Hospital Quality Incentive Demonstration (PHQID), a public quality reporting and pay-for-performance (P4P) program, on Medicare patient mortality, cost, and outlier classification. DATA SOURCES The 2000-2006 Medicare inpatient claims, Medicare denominator files, and Medicare Provider of Service files. STUDY DESIGN Panel data econometric methods are applied to a retrospective cohort of 11,232,452 admissions from 6,713,928 patients with principal diagnoses of acute myocardial infarction (AMI), heart failure, pneumonia, or a coronary-artery bypass grafting (CABG) procedure from 3,570 acute care hospitals between 2000 and 2006. Three estimators are used to evaluate the effects of the PHQID on risk-adjusted (RA) mortality, cost, and outlier classification in the presence of unobserved selection, resulting from the PHQID being voluntary: fixed effects (FE), FE estimated in the subset of hospitals eligible for the PHQID, and difference-in-difference-in-differences. DATA EXTRACTION METHODS Data were obtained from CMS. Principal Findings. This analysis found no evidence that the PHQID had a significant effect on RA 30-day mortality or RA 60-day cost for AMI, heart failure, pneumonia, or CABG and weak evidence that the PHQID increased RA outlier classification for heart failure and pneumonia. CONCLUSIONS By not reducing mortality or cost growth, this study suggests that the PHQID has made little impact on the value of inpatient care purchased by Medicare.
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Arling G, Job C, Cooke V. Medicaid Nursing Home Pay for Performance: Where Do We Stand? THE GERONTOLOGIST 2009; 49:587-95. [DOI: 10.1093/geront/gnp044] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Oxman AD, Fretheim A. Can paying for results help to achieve the Millennium Development Goals? Overview of the effectiveness of results-based financing. J Evid Based Med 2009; 2:70-83. [PMID: 21348993 DOI: 10.1111/j.1756-5391.2009.01020.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Results-based financing and pay-for-performance refer to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. Results-based financing is widely advocated for achieving health goals, including the Millennium Development Goals. METHODS We undertook an overview of systematic reviews of the effectiveness of RBF. We searched the Cochrane Library, EMBASE, and MEDLINE (up to August 2007). We also searched for related articles in PubMed, checked the reference lists of retrieved articles, and contacted key informants. We included reviews with a methods section that addressed the effects of any results-based financing in the health sector targeted at patients, providers, organizations, or governments. We summarized the characteristics and findings of each review using a structured format. RESULTS We found 12 systematic reviews that met our inclusion criteria. Based on the findings of these reviews, financial incentives targeting recipients of health care and individual healthcare professionals are effective in the short run for simple and distinct, well-defined behavioral goals. There is less evidence that financial incentives can sustain long-term changes. Conditional cash transfers to poor and disadvantaged groups in Latin America are effective at increasing the uptake of some preventive services. There is otherwise very limited evidence of the effects of results-based financing in low- or middle-income countries. Results-based financing can have undesirable effects, including motivating unintended behaviors, distortions (ignoring important tasks that are not rewarded with incentives), gaming (improving or cheating on reporting rather than improving performance), widening the resource gap between rich and poor, and dependency on financial incentives. CONCLUSION There is limited evidence of the effectiveness of results-based financing and almost no evidence of the cost-effectiveness of results-based financing. Based on the available evidence and likely mechanisms through which financial incentives work, they are more likely to influence discrete individual behaviors in the short run and less likely to create sustained changes.
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Affiliation(s)
- Andrew D Oxman
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway.
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Lippi Bruni M, Nobilio L, Ugolini C. Economic incentives in general practice: The impact of pay-for-participation and pay-for-compliance programs on diabetes care. Health Policy 2009; 90:140-8. [DOI: 10.1016/j.healthpol.2008.09.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 09/10/2008] [Accepted: 09/14/2008] [Indexed: 10/21/2022]
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Teng GG, Curtis JR, Saag KG. Quality health care gaps in osteoporosis: how can patients, providers, and the health system do a better job? Curr Osteoporos Rep 2009; 7:27-34. [PMID: 19239827 DOI: 10.1007/s11914-009-0006-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A significant gap exists between evidence-based advances and real-world clinical practice in the diagnosis and prevention of osteoporosis. The goal of osteoporosis care is to prevent fractures and improve health-related quality of life, and ideally lower mortality. Despite recent advances in osteoporosis detection and treatment options, studies suggest underdiagnosis and undertreatment of osteoporosis, even among those who have already sustained fractures. The challenges in translating knowledge into practice are multifaceted, with efforts directed at the patient, provider, and health care system levels achieving variable success at the population level. Methods to improve quality of care in osteoporosis need to be multipronged, with emphasis on clinical process improvement and reliance on interdisciplinary teams. We review the growing literature on quality of care for osteoporosis.
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Affiliation(s)
- Gim Gee Teng
- Center for Education and Research on Therapeutics of Musculoskeletal Disorders, and Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 510 20th Street South, Birmingham, AL 35294-3708, USA
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Yoast RA, Wilford BB, Hayashi SW. Encouraging physicians to screen for and intervene in substance use disorders: obstacles and strategies for change. J Addict Dis 2008; 27:77-97. [PMID: 18956531 DOI: 10.1080/10550880802122687] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The scientific literature was reviewed to identify obstacles and effective ways to improve primary care physician screening, interventions, and management of patient substance use disorders (SUDs). Major obstacles identified are physician lack of skills and self-efficacy in patient counseling, inadequate training at all levels of medical education, and lack of reimbursement and other health care systems support for services to patients. Physician abuse of drugs does not appear to be a major obstacle. Physician attitudes about patients with SUDS and the effectiveness of treatment services need to be addressed. Research points to the use of a multifaceted change strategy. Key components include practice-based training emphasizing screening and counseling skills throughout medical education, clinical systems to ensure regular SUD services (screening, intervention, and referral) to patients, and reimbursement and coverage systems to support physician interventions and patient services.
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Affiliation(s)
- Richard A Yoast
- Department of Public Policy and Primary Prevention, American Medical Association, 515 North State Street, Chicago, IL 60610, USA.
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71
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Christianson JB, Leatherman S, Sutherland K. Lessons From Evaluations of Purchaser Pay-for-Performance Programs. Med Care Res Rev 2008; 65:5S-35S. [DOI: 10.1177/1077558708324236] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There has been a growing interest in the use of financial incentives to encourage improvements in the quality of health care. Several articles have reviewed past studies of the impact of specific incentive arrangements, but these studies addressed small-scale experiments, making their findings arguably of limited relevance to current improvement efforts. In this article, the authors review evaluations of more recent pay-for-performance initiatives instituted by health plans or by provider organizations in cooperation with health plans. Findings show improvement in selected quality measures in most of these initiatives, but the contribution of financial incentives to that improvement is not clear; the incentives typically were implemented in conjunction with other quality improvement efforts, or there was not a convincing comparison group. However, the literature relating to purchaser pay-for-performance initiatives does underscore several important issues that deserve attention going forward that relate to the design and implementation of pay-for-performance initiatives.
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72
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Leijon ME, Bendtsen P, Nilsen P, Ekberg K, Ståhle A. Physical activity referrals in Swedish primary health care - prescriber and patient characteristics, reasons for prescriptions, and prescribed activities. BMC Health Serv Res 2008; 8:201. [PMID: 18828898 PMCID: PMC2567971 DOI: 10.1186/1472-6963-8-201] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2008] [Accepted: 10/01/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past decade, practitioners in primary health care (PHC) settings in many countries have issued written prescriptions to patients to promote increased physical activity or exercise. The aim of this study is to describe and analyse a comprehensive physical activity referral (PAR) scheme implemented in a routine PHC setting in Ostergötland County. The study examines characteristics of the PARs recipients and referral practitioners, identifies reasons why practitioners opted to use PARs with their clients, and discusses prescribed activities and prescriptions in relation to PHC registries. METHODS Prospective prescription data were obtained for 90% of the primary health care centres in Ostergötland County, Sweden, in 2004 and 2005. The study population consisted of patients who were issued PARs after they were deemed likely to benefit from increased physical activity, as assessed by PHC staff. RESULTS During the two-year period, a total of 6,300 patients received PARs. Two-thirds of the patients were female and half of the patients were 45-64 years. Half of the patients (50.8%) who received PARs were recommended a home-based activity, such as walking. One third (33%) of the patients issued PARs were totally inactive, reporting no days of physical activity that lasted for 30 minutes, and 29% stated that they reached this level 1-2 days per week. The number of PARs prescribed per year in relation to the number of unique individuals that visited primary health care during one year was 1.4% in 2004 and 1.2% in 2005. Two-thirds of the combined prescriptions were issued by physicians (38%) and nurses (31%). Physiotherapists and behavioural scientists issued the highest relative number of prescriptions. The most common reasons for issuing PARs were musculoskeletal disorders (39.1%) and overweight (35.4%), followed by high blood pressure (23.3%) and diabetes (23.2%). CONCLUSION Ostergötland County's PAR scheme reached a relatively high proportion of physically inactive people visiting local PHC centres for other health reasons. PAR-related statistics, including PAR-rates by individual PHC centres and PAR- rates per health professional category, show differences in prescribing activities, both by patient categories, and by prescribing professionals.
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Affiliation(s)
- ME Leijon
- Department of Medical and Health Sciences, Social Medicine and Public Health Science, Linköping Universitet, S-581 83 Linköping, Sweden
- Centre for Public Health Sciences, County Council of Östergötland, Linköping, Sweden
| | - P Bendtsen
- Department of Medical and Health Sciences, Social Medicine and Public Health Science, Linköping Universitet, S-581 83 Linköping, Sweden
| | - P Nilsen
- Department of Medical and Health Sciences, Social Medicine and Public Health Science, Linköping Universitet, S-581 83 Linköping, Sweden
| | - K Ekberg
- Department of Medical and Health Sciences, National Centre for Work and Rehabilitation, Linköping Universitet S-581 83 Linköping, Sweden
| | - A Ståhle
- Department of Neurobiology, Health Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine, Division of Cardiology, Karolinska Institutet, and Department of Physiotherapy, Karolinska Hospital, Stockholm, Sweden
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73
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Devlin RA, Sarma S. Do physician remuneration schemes matter? The case of Canadian family physicians. JOURNAL OF HEALTH ECONOMICS 2008; 27:1168-81. [PMID: 18586341 DOI: 10.1016/j.jhealeco.2008.05.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 05/02/2008] [Accepted: 05/14/2008] [Indexed: 05/25/2023]
Abstract
Although it is well known theoretically that physicians respond to financial incentives, the empirical evidence is quite mixed. Using the 2004 Canadian National Physician Survey, we analyze the number of patient visits per week provided by family physicians in alternative forms of remuneration schemes. Overwhelmingly, fee-for-service (FFS) physicians conduct more patient visits relative to four other types of remuneration schemes examined in this paper. We find that family physicians self-select into different remuneration regimes based on their personal preferences and unobserved characteristics; OLS estimates plus the estimates from an IV GMM procedure are used to tease out the magnitude of the selection and incentive effects. We find a positive selection effect and a large negative incentive effect; the magnitude of the incentive effect increases with the degree of deviation from a FFS scheme. Knowledge of the extent to which remuneration schemes affect physician output is an important consideration for health policy.
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Affiliation(s)
- Rose Anne Devlin
- Department of Economics, University of Ottawa, Ottawa, Ontario, Canada K1N 6N5.
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74
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Campbell SM, McDonald R, Lester H. The experience of pay for performance in English family practice: a qualitative study. Ann Fam Med 2008; 6:228-34. [PMID: 18474885 PMCID: PMC2384990 DOI: 10.1370/afm.844] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We conducted an in-depth exploration of family physicians' and nurses' beliefs and concerns about changes to the family health care service as a result of the new pay-for-performance scheme in the United Kingdom (Quality and Outcomes Framework [QOF]). METHODS Using a semistructured interview format, we interviewed 21 family doctors and 20 nurses in 22 nationally representative practices across England between February and August 2007. RESULTS Participants believed the financial incentives had been sufficient to change behavior and to achieve targets. The findings suggest that it is not necessary to align targets to professional priorities and values to obtain behavior change, although doing so enhances enthusiasm and understanding. Participants agreed that the aims of the pay-for-performance scheme had been met in terms of improvements in disease-specific processes of patient care and physician income, as well as improved data capture. It also led to unintended effects, such as the emergence of a dual QOF-patient agenda within consultations, potential deskilling of doctors as a result of the enhanced role for nurses in managing long-term conditions, a decline in personal/relational continuity of care between doctors and patients, resentment by team members not benefiting financially from payments, and concerns about an ongoing culture of performance monitoring in the United Kingdom. CONCLUSIONS The QOF scheme may have achieved its declared objectives of improving disease-specific processes of patient care through the achievement of clinical and organizational targets and increased physician income, but our findings suggest that it has changed the dynamic between doctors and nurses and the nature of the practitioner-patient consultation.
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Affiliation(s)
- Stephen M Campbell
- National Primary Care Research and Development Centre, the University of Manchester, Manchester, UK.
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76
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Craig TJ, Perlin JB, Fleming BB. Self-reported performance improvement strategies of highly successful Veterans Health Administration facilities. Am J Med Qual 2008; 22:438-44. [PMID: 18006424 DOI: 10.1177/1062860607304928] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Veterans Health Administration (VHA) has achieved considerable success in improving health care through the use of clinical performance measures. This report examines the self-reported strategies used by the most successful facilities in the VHA system. For fiscal year 2002, facilities that scored the highest on any of 24 clinical performance measures were queried as to which strategies they used to achieve their level of performance. The most commonly cited strategies across all performance categories were organizational change (55.6%), clinical reminders (41.4%), audit and feedback to providers (39.6%), and staff education (32.5%). Certain strategies were more likely to be cited for 1 or more specific performance categories (eg, clinical reminders for immunization [61.1%], screening [60.6%]). These findings suggest that successful facilities are generally using evidence-based strategies to achieve high clinical performance. However, some evidence-based implementation strategies were rarely cited (eg, use of clinical champions).
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Affiliation(s)
- Thomas J Craig
- Department of Veterans Affairs, Office of Quality and Performance, Washington, DC, USA.
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77
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Althabe F, Bergel E, Cafferata ML, Gibbons L, Ciapponi A, Alemán A, Colantonio L, Palacios AR. Strategies for improving the quality of health care in maternal and child health in low- and middle-income countries: an overview of systematic reviews. Paediatr Perinat Epidemiol 2008; 22 Suppl 1:42-60. [PMID: 18237352 DOI: 10.1111/j.1365-3016.2007.00912.x] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
There are many systematic reviews of continuing education programmes and educational strategies for quality improvement in health care. Most of the reviewed studies are one-off evaluations rather than impact evaluations with long-term follow-up. There are few systematic reviews of organisational, financial and regulatory interventions, and few high-quality studies. These interventions are probably as or more important than educational strategies, although they are less well evaluated. Few studies have been undertaken in low- and middle-income countries (LMIC) or that address maternal and child health (MCH). Thus, the results of the available studies and reviews need to be interpreted cautiously when applied to LMIC. Interactive workshops, reminders and multifaceted interventions can improve professional practice, and they generally have moderate effects. Educational outreach visits consistently improve prescribing but have variable effects on other behaviours. Audit and feedback interventions have variable effects on professional practice, but most often these are small to moderate effects. Mass-media and patient-mediated interventions may change professional practice. Multifaceted interventions that combine several quality-improvement strategies are also effective but may not be more so than single interventions. While all of these strategies are applicable to MCH in LMIC, the applicability of the results to rural settings, in particular, may be limited. Use of these strategies could exacerbate inequalities, and this should be taken into consideration when planning implementation. Scaling up and sustainability may be difficult to achieve in LMIC contexts and need careful consideration. The use of financial interventions has not been well studied; financial incentives and disincentives may be difficult to use effectively and efficiently, although their impact on practice needs to be considered. Organisational interventions are likely to be important, given that there are often underlying organisational or system problems. Regulatory interventions have not been well evaluated, but may sometimes be both inexpensive and effective. There are no 'magic bullets' or simple solutions for ensuring the quality of health care services. Interventions should be selected or tailored to address the underlying reasons for a failure to deliver effective services. Decision-makers should select the most appropriate interventions for specific problems. This requires a governance structure that clearly assigns responsibility for quality-improvement activities, priority setting, selection and design of interventions, and evaluation.
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Affiliation(s)
- Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina.
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78
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Grol RPTM, Bosch MC, Hulscher MEJL, Eccles MP, Wensing M. Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q 2007; 85:93-138. [PMID: 17319808 PMCID: PMC2690312 DOI: 10.1111/j.1468-0009.2007.00478.x] [Citation(s) in RCA: 572] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A consistent finding in articles on quality improvement in health care is that change is difficult to achieve. According to the research literature, the majority of interventions are targeted at health care professionals. But success in achieving change may be influenced by factors other than those relating to individual professionals, and theories may help explain whether change is possible. This article argues for a more systematic use of theories in planning and evaluating quality-improvement interventions in clinical practice. It demonstrates how different theories can be used to generate testable hypotheses regarding factors that influence the implementation of change, and it shows how different theoretical assumptions lead to different quality-improvement strategies.
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Affiliation(s)
- Richard P T M Grol
- Centre for Quality of Care Research, Radboud University Nijmegen Medical Centre, Radboud University Nijmegen, Nijmegen, the Netherlands.
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Conrad DA, Saver BG, Court B, Heath S. Paying Physicians for Quality: Evidence and Themes from the Field. Jt Comm J Qual Patient Saf 2006; 32:443-51. [PMID: 16955863 DOI: 10.1016/s1553-7250(06)32058-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Health plans, self-insured employers, health plans, and provider organizations are currently introducing financial incentives that reward physicians for delivering high-quality medical care. Yet a review of existing research reveals virtually no empirical studies of the effect of direct, internal quality incentives on physician performance. Key-informant interviews with leaders of provider organizations should shed new light on evolving quality incentives within organizations. METHODS Structured key-informant interviews with administrators and medical directors in 22 medical groups and 9 hospitals affiliated with 10 large, integrated health systems were conducted from July 2003 through January 2004. FINDINGS Views on the role of financial incentives varied widely and were related to a number of other factors, including institutional culture, community context, organizational strategy and structure, organizational stability, quality measurement, nature and size of incentives, and the sustainability of interventions. DISCUSSION These findings have implications for the acceptability and structure of financial incentives for quality directed to health care provider organizations. A set of considerations for the design and implementation of quality incentives relate to the incentives' scope, controllability, transparency, size, and orientation (individual or team), as well as the relationship between the extrinsic financial incentives and professionals' intrinsic motivation.
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Affiliation(s)
- Douglas A Conrad
- Department of Health Services, Magnuson Health Sciences Center, University of Washington, Seattle, USA.
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80
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Miller WR, Baca C, Compton WM, Ernst D, Manuel JK, Pringle B, Schermer CR, Weiss RD, Willenbring ML, Zweben A. Addressing substance abuse in health care settings. Alcohol Clin Exp Res 2006; 30:292-302. [PMID: 16441278 DOI: 10.1111/j.1530-0277.2006.00027.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article summarizes the proceedings of a roundtable discussion at the 2005 annual meeting of the Research Society on Alcoholism in Santa Barbara, California. The chair was William R. Miller. The presentations were as follows: (1) Screening and Brief Intervention for Alcohol Problems, by Allen Zweben; (2) Three Intervention Models and Their Impact on Medical Records, by Denise Ernst; (3) Pharmacotherapies for Managing Alcohol Dependence in Health Care Settings, by Roger D. Weiss; (4) The Trauma Center as an Opportunity, by Carol R. Schermer; (5) Motivational Interviewing by Telephone and Telemedicine, by Catherine Baca; (6) Health Care as a Context for Treating Drug Abuse and Dependence, by Wilson M. Compton; and (7) Interventions for Heavy Drinking in Health Care settings: Barriers and Strategies, by Mark L. Willenbring.
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Affiliation(s)
- William R Miller
- University of Mexico Center on Alcoholism, Substance Abuse and Addictions (CASAA)
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81
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Freed GL, Uren RL. Pay-for-performance: an overview for pediatrics. J Pediatr 2006; 149:120-4. [PMID: 16860139 DOI: 10.1016/j.jpeds.2006.03.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 02/16/2006] [Accepted: 03/15/2006] [Indexed: 11/29/2022]
Affiliation(s)
- Gary L Freed
- Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan, USA.
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82
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Miller DC, Wei JT, Montie JE, Hollenbeck BK. Quality of care and performance-based reimbursement: The contemporary landscape and implications for urologists. Urology 2006; 67:1117-25. [PMID: 16765163 DOI: 10.1016/j.urology.2006.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2005] [Revised: 11/17/2005] [Accepted: 01/03/2006] [Indexed: 11/18/2022]
Affiliation(s)
- David C Miller
- Division of Clinical Research and Quality Assurance, Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0330, USA
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83
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Smith JM, Craig TJ. Strategies for improving pneumococcal vaccination in eligible patients. Curr Infect Dis Rep 2006; 8:231-7. [PMID: 16643775 DOI: 10.1007/s11908-006-0064-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Despite the fact that invasive Streptococcus pneumoniae remains a leading cause of death, current levels of immunization in the at risk population remain low and well below the 90% goal for Healthy People 2010. A number of intervention strategies to increase immunization rates (for influenza and pneumonia) have been demonstrated to be effective in increasing these rates when used alone or in combination. A summary of this literature is presented including recent data on the effectiveness of pay-for-performance approaches for increasing preventive care. Data are also presented on intervention strategies judged to be most effective in a large health care system, the Veterans Health Administration, which has essentially reached the Healthy People 2010 goal for pneumococcal immunization.
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Affiliation(s)
- James M Smith
- Quality Management Officer, Veterans Integrated Service Network #3, 130 W. Kingsbridge Road, Bronx, NY 10468, USA.
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84
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Grembowski D, Spiekerman C, del Aguila MA, Anderson M, Reynolds D, Ellersick A, Foster J, Choate L. Randomized pilot study to disseminate caries-control services in dentist offices. BMC Oral Health 2006; 6:7. [PMID: 16670027 PMCID: PMC1513219 DOI: 10.1186/1472-6831-6-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2005] [Accepted: 05/03/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine whether education and financial incentives increased dentists' delivery of fluoride varnish and sealants to at risk children covered by capitation dental insurance in Washington state (U.S.). METHODS In 1999, 53 dental offices in Washington Dental Service's capitation dental plan were invited to participate in the study, and consenting offices were randomized to intervention (n = 9) and control (n = 10) groups. Offices recruited 689 capitation children aged 6-14 and at risk for caries, who were followed for 2 years. Intervention offices received provider education and fee-for-service reimbursement for delivering fluoride varnish and sealants. Insurance records were used to calculate office service rates for fluoride, sealants, and restorations. Parents completed mail surveys after follow-up to measure their children's dental utilization, dental satisfaction, dental fear and oral health status. Regression models estimated differences in service rates between intervention and control offices, and compared survey measures between groups. RESULTS Nineteen offices (34%) consented to participate in the study. Fluoride and sealant rates were greater in the intervention offices than the control offices, but the differences were not statistically significant. Restoration rates were lower in the intervention offices than the control offices. Parents in the intervention group reported their children had less dental fear than control group parents. CONCLUSION Due to low dentist participation the study lacked power to detect an intervention effect on dentists' delivery of caries-control services. The intervention may have reduced children's dental fear.
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Affiliation(s)
- David Grembowski
- Department of Dental Public Health Sciences, Box 357475, University of Washington, Seattle, WA, 98195, USA
- Department of Health Services, University of Washington, Box 357660, Seattle, WA, 98195, USA
| | - Charles Spiekerman
- Department of Dental Public Health Sciences, Box 357475, University of Washington, Seattle, WA, 98195, USA
| | | | - Maxwell Anderson
- Delta Dental Washington Dental Service, P.O. Box 75688, Seattle, WA, 98175-0688, USA
| | - Debra Reynolds
- Delta Dental Washington Dental Service, P.O. Box 75688, Seattle, WA, 98175-0688, USA
| | - Allison Ellersick
- Delta Dental Washington Dental Service, P.O. Box 75688, Seattle, WA, 98175-0688, USA
| | - James Foster
- Delta Dental Washington Dental Service, P.O. Box 75688, Seattle, WA, 98175-0688, USA
| | - Leslie Choate
- Delta Dental Washington Dental Service, P.O. Box 75688, Seattle, WA, 98175-0688, USA
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Shanahan M, Shakeshaft A, Mattick RP. Modelling the costs and outcomes of changing rates of screening for alcohol misuse by GPs in the Australian context. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2006; 5:155-66. [PMID: 17132030 DOI: 10.2165/00148365-200605030-00002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIM To assess the relative cost effectiveness of four strategies (academic detailing, computerised reminder systems, target payments and interactive continuing medical education) to increase the provision of screening and brief interventions by Australian GPs with the ultimate goal of decreasing risky alcohol consumption among their patients. METHODS This project used a modelling approach to combine information on the effectiveness and costs of four separate strategies to change GP behaviours to estimate their relative cost effectiveness. RESULTS The computerised reminder system and academic detailing appear most effective in achieving a decrease in the number of standard drinks consumed by risky drinkers. CONCLUSION Regardless of the assumptions made, the targeted payment strategy appeared to be the least cost-effective method to achieve a decrease in risky alcohol consumption while the other three strategies appear reasonably comparable.
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Affiliation(s)
- Marian Shanahan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
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86
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Crabtree BF, Miller WL, Tallia AF, Cohen DJ, DiCicco-Bloom B, McIlvain HE, Aita VA, Scott JG, Gregory PB, Stange KC, McDaniel RR. Delivery of clinical preventive services in family medicine offices. Ann Fam Med 2005; 3:430-5. [PMID: 16189059 PMCID: PMC1466921 DOI: 10.1370/afm.345] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study aimed to elucidate how clinical preventive services are delivered in family practices and how this information might inform improvement efforts. METHODS We used a comparative case study design to observe clinical preventive service delivery in 18 purposefully selected Midwestern family medicine offices from 1997 to 1999. Medical records, observation of outpatient encounters, and patient exit cards were used to calculate practice-level rates of delivery of clinical preventive services. Field notes from direct observation of clinical encounters and prolonged observation of the practice and transcripts from in-depth interviews of practice staff and physicians were systematically examined to identify approaches to delivering clinical preventive services recommended by the US Preventive Services Task Force. RESULTS Practices developed individualized approaches for delivering clinical preventive services, with no one approach being successful across practices. Clinicians acknowledged a 3-fold mission of providing acute care, managing chronic problems, and prevention, but only some made prevention a priority. The clinical encounter was a central focus for preventive service delivery in all practices. Preventive services delivery rates often appeared to be influenced by competing demands within the clinical encounter (including between different preventive services), having a physician champion who prioritized prevention, and economic concerns. CONCLUSIONS Practice quality improvement efforts that assume there is an optimal approach for delivering clinical preventive services fail to account for practices' propensity to optimize care processes to meet local contexts. Interventions to enhance clinical preventive service delivery should be tailored to meet the local needs of practices and their patient populations.
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Affiliation(s)
- Benjamin F Crabtree
- Department of Family Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08873, USA.
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