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Published on: February 19, 2021
Alternative pay-for-performance scoring methods: implications for quality improvement and patient outcomes.
Seth W Glickman1, William Boulding, Jason M T Roos
1Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA.
Medical Care
|August 4, 2009
Summary
New hospital scoring methods focusing on how care is organized, not just total opportunities, better predict patient survival. Prioritizing administrative tasks over clinical ones may harm outcomes.
Area of Science:
- Health Services Research
- Quality Improvement
- Cardiovascular Medicine
Background:
- Pay-for-performance programs often use composite scores weighted by treatment opportunities.
- Alternative scoring methods considering care organization and improvement potential may better reflect patient outcomes.
Purpose of the Study:
- Develop a hospital-level adherence score reflecting cardiac care organization and improvement potential.
- Compare this novel score with the Centers for Medicare and Medicaid Services (CMS) composite score in relation to inpatient mortality.
Main Methods:
- Analysis of 7 acute myocardial infarction (AMI) and 4 heart failure process measures across 4226 US hospitals.
- Examined associations between CMS and alternative adherence scores with inpatient mortality after AMI in 1351 hospitals.
Main Results:
- Hospital cardiac care organized into 'clinical' and 'administrative' activities.
- The novel scoring system aligned better with mortality data and predicted inpatient survival more effectively than the CMS composite score.
- Higher scores for administrative activities, with fixed clinical scores, correlated with decreased survival.
Conclusions:
- In-hospital cardiac care involves distinct clinical and administrative processes.
- Pay-for-performance incentives focusing on administrative measures may inadvertently reduce adherence to clinical processes.
- A pay-for-performance system acknowledging care organization could improve inpatient mortality outcomes.
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