業績,医療の質,急性心筋梗塞における結果に対する報酬
Seth W Glickman1, Fang-Shu Ou, Elizabeth R DeLong
1Center for Clinical and Genetic Economics, Duke University Medical Center, Durham, NC, USA.
JAMA
|June 7, 2007
まとめ
パフォーマンスのための報酬 (P4P) プログラムは,急性心筋梗塞のケアや,大規模なパイロット研究におけるアウトカムを有意に改善しませんでした. また,このイニシアチブは,非インセンティブケアプロセスに悪影響を与えないことも示されました.
科学分野:
- 医療サービス 研究 医療サービス
- 品質改善イニシアティブ 品質改善イニシアティブ
- 心血管医学 心血管医学
背景:
- パフォーマンスの報酬 (P4P) は,医療の質を高めるための戦略です.
- Medicare & Medicaid Services (CMS) のセンターは,急性心筋梗塞 (AMI) のケア指標を含む大規模なP4Pパイロットプロジェクトを2003年に開始しました.
研究 の 目的:
- P4PとAMIケアプロセスと成果の改善との関連性を評価する.
- P4Pが非インセンティブケアに及ぼす意図せぬ影響を特定する.
主な方法:
- 2003年7月から2006年6月までの105,383人のAMI患者の観察的,患者レベルの分析.
- 54のP4P参加病院と,CRUSADE品質改善イニシアチブ内の446の対照病院を比較しました.
- ACC/AHAのガイドラインによる治療法と入院死亡率の評価.
主要な成果:
- P4P病院での6つのP4P誘導療法 (アスピリン,禁煙) のうち2つの改善率がわずかに高かった (P=.04,P=.05).
- P4Pと対照群の間で,インセンティブ付きまたはインセンティブのない治療のための複合的な測定では,大きな違いはありません.
- P4Pサイト (P=.21) で観察された入院死亡率の漸進的な改善はありません.
結論:
- CMS P4Pプログラムは,AMIのケア品質またはアウトカムにおける有意なインクリメンタル改善と関連付けられませんでした.
- P4Pと非インセンティブケアプロセスの改善との間に有害な関連は見つかりませんでした.
- 品質改善におけるP4Pの最適な役割を定義するために,さらなる研究が必要である.
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