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Arch Pediatr Adolesc Med. 2007 Jul;161(7):650-5.

Pay for performance alone cannot drive quality.

Author information

1
Physician-Hospital Organization, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. keith.mandel@cchmc.org

Abstract

OBJECTIVE:

To determine whether aligning design characteristics of a pay-for-performance program with objectives of an asthma improvement collaborative builds improvement capability and accelerates improvement.

DESIGN:

Interrupted time series analysis of the impact of pay for performance on results of an asthma improvement collaborative.

SETTING:

Forty-four pediatric practices within greater Cincinnati.

PARTICIPANTS:

Forty-four pediatric practices with 13 380 children with asthma.

INTERVENTIONS:

The pay-for-performance program rewarded practices for participating in the collaborative, achieving network- and practice-level performance thresholds, and building improvement capability. Pay for performance was coupled with additional improvement interventions related to the collaborative.

OUTCOME MEASURES:

Flu shot percentage, controller medication percentage for children with persistent asthma, and written self-management plan percentage.

RESULTS:

The pay-for-performance program provided each practice with the potential to earn a 7% fee schedule increase. Three practices earned a 2% increase, 13 earned a 4% increase, 2 earned a 5% increase, 14 earned a 6% increase, and 11 earned a 7% increase. Between October 1, 2003, and November 30, 2006, the percentage of the network asthma population receiving "perfect care" increased from 4% to 88%. The percentage of the network asthma population receiving the influenza vaccine increased from 22% to 41%, and then to 62% during the prior 3 flu seasons.

CONCLUSION:

Linking design characteristics of a pay-for-performance program to a collaborative focused on improving care for a defined population, building improvement capability, and driving system changes at the provider level resulted in substantive and sustainable improvement.

PMID:
17606827
DOI:
10.1001/archpedi.161.7.650
[Indexed for MEDLINE]

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