Provider attitudes toward pay-for-performance programs: development and validation of a measurement instrument

Area of Science:

• Health Services Research
• Medical Economics
• Physician Behavior Studies

Background:

• Quality incentive programs, such as pay-for-performance (P4P), are increasingly implemented to improve healthcare quality.
• Understanding physician attitudes towards these programs is crucial for their successful design and implementation.
• Existing instruments may not adequately capture the multifaceted nature of physician perceptions regarding P4P.

Purpose of the Study:

• To develop and validate a reliable instrument for assessing physician attitudes toward quality incentive programs.
• To identify key constructs influencing physician perceptions of pay-for-performance (P4P) programs.

Main Methods:

• A 40-item survey was developed based on literature review and expert consultation, then pilot tested.
• The revised 26-item survey was administered to 2,497 primary care physicians.
• Exploratory factor analysis and multitrait analysis (MTA) were used to assess reliability and validity.

Main Results:

• Seven key constructs were identified: awareness and understanding, clinical relevance, cooperation, unintended consequences, control, financial salience, and impact.
• The instrument demonstrated substantial convergent and discriminant validity.
• Internal consistency reliabilities (Cronbach's alpha) ranged from 0.50 to 0.80.

Conclusions:

• A valid and reliable 26-item survey instrument for assessing physician attitudes toward P4P programs has been developed.
• This instrument can be utilized in future research to investigate the impact of P4P programs on physician behavior.
• The findings provide a tool for better understanding physician engagement with quality incentive initiatives.