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Published on: February 16, 2011

Pay for performance alone cannot drive quality

Keith E Mandel1, Uma R Kotagal

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

Archives of Pediatrics & Adolescent Medicine
|July 4, 2007
PubMed

Insights

Pay-for-performance programs linked to asthma improvement collaboratives enhance care delivery. This strategy significantly improved patient outcomes and practice capabilities in pediatric settings.

Area of Science:

  • Health Services Research
  • Quality Improvement Science

Background:

  • Asthma management requires coordinated care and continuous quality improvement.
  • Pay-for-performance (PFP) programs can incentivize practice changes, but their alignment with collaborative goals is crucial.

Purpose of the Study:

  • To evaluate if aligning PFP program design with an asthma improvement collaborative's objectives enhances practice improvement capability and accelerates care quality.
  • To assess the impact of a PFP program integrated with an asthma collaborative on pediatric asthma care outcomes.

Main Methods:

  • Interrupted time series analysis was employed to assess the impact of PFP on collaborative results.
  • The study involved 44 pediatric practices and 13,380 children with asthma in Cincinnati.
  • The PFP program incentivized participation, performance thresholds, and capability building, alongside collaborative interventions.

Main Results:

  • Practices could earn up to a 7% fee increase; financial incentives were distributed based on performance.
  • The percentage of the network asthma population receiving "perfect care" surged from 4% to 88% between 2003 and 2006.
  • Influenza vaccination rates increased from 22% to 62% over three flu seasons.

Conclusions:

  • Aligning PFP program design with a collaborative focused on improving care for a defined population fosters substantial and lasting improvements.
  • Integrating PFP with collaborative efforts drives system changes at the provider level, enhancing overall care quality and patient outcomes.
Abstract

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