Pay-for-Performance Research

Dudley, R. Adams

doi:10.1001/jama.294.14.1821

Cited by 70 publications

(19 citation statements)

References 6 publications

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“…Few studies have examined the impact of pay-for-performance incentives on variations in chronic disease management and outcomes [14,15]. Complementary quality improvement strategies in diabetes management have shown small to modest improvements in glycaemic management in controlled trial settings [8].…”

Section: Discussionmentioning

confidence: 99%

“…The use of pay-for-performance incentive schemes as a quality improvement tool is increasing, particularly in the US and UK [14,15]. Such schemes aim to improve the quality of health care for all patients so that it meets established standards, and therefore they provide an important opportunity to address disparities in chronic disease management between different ethnic and socioeconomic groups [16,17].…”

Section: Introductionmentioning

confidence: 99%

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Ethnic Disparities in Diabetes Management and Pay-for-Performance in the UK: The Wandsworth Prospective Diabetes Study

Gray²,

et al. 2007

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BackgroundPay-for-performance rewards health-care providers by paying them more if they succeed in meeting performance targets. A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay-for-performance seen in any health-care system. The contract provides an important opportunity to address disparities in chronic disease management between ethnic and socioeconomic groups. We examined disparities in management of people with diabetes and intermediate clinical outcomes within a multiethnic population in primary care before and after the introduction of the new contract in April 2004.Methods and FindingsWe conducted a population-based longitudinal survey, using electronic general practice records, in an ethnically diverse part of southwest London. Outcome measures were prescribing levels and achievement of national treatment targets (HbA1c ≤ 7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol ≤ 5 mmol/l or 193 mg/dl). The proportion of patients reaching treatment targets for HbA1c, BP, and total cholesterol increased significantly after the implementation of the new contract. The extents of these increases were broadly uniform across ethnic groups, with the exception of the black Caribbean patient group, which had a significantly lower improvement in HbA1c (adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.57–0.97) and BP control (AOR 0.65, 95% CI 0.53–0.81) relative to the white British patient group. Variations in prescribing and achievement of treatment targets between ethnic groups present in 2003 were not attenuated in 2005.ConclusionsPay-for-performance incentives have not addressed disparities in the management and control of diabetes between ethnic groups. Quality improvement initiatives must place greater emphasis on minority communities to avoid continued disparities in mortality from cardiovascular disease and the other major complications of diabetes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ethnic Disparities in Diabetes Management and Pay-for-Performance in the UK: The Wandsworth Prospective Diabetes Study

Gray²,

et al. 2007

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“…3 More pressing, is it even possible to reach the goal of a payment system that promotes both increased quality and reduced costs? 13, 50 This paper was intended to shed some optimistic light on how we might meet this challenge with regards to the reimbursement of primary care providers. We hope that our illustration of the theoretic potential of blended payments will encourage further research and development of blended payment models.…”

Section: Discussionmentioning

confidence: 99%

“…8,9,10,11,12 However, there is currently limited information and serious skepticism about how (and if) a blended mechanism could work effectively. 2, 13,14,15,16 In this critical review, we use the ‘prisoner’s dilemma’ aspect of economic game theory to highlight perversities inherent in current primary care payment mechanisms and to illuminate how blended payments might provide an escape from perverse financial incentives that prevent primary care providers from reforming the health care system to better promote health. 17 …”

Section: Introductionmentioning

confidence: 99%

Aligning provider incentives to improve primary health care delivery in the United States

Je¹,

Stenger²

2013

OA Family Medicine

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“…This trial addresses the needs of policy makers, payers, physicians, administrators, and others for information about a clinically relevant intervention in routine practice. We are not aware of other ongoing randomized trials of pay for performance directed at physicians and provider groups [11]. …”

Section: Introductionmentioning

confidence: 99%

Design, rationale, and baseline characteristics of a cluster randomized controlled trial of pay for performance for hypertension treatment: study protocol

et al. 2011

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BackgroundDespite compelling evidence of the benefits of treatment and well-accepted guidelines for treatment, hypertension is controlled in less than one-half of United States citizens.Methods/designThis randomized controlled trial tests whether explicit financial incentives promote the translation of guideline-recommended care for hypertension into clinical practice and improve blood pressure (BP) control in the primary care setting. Using constrained randomization, we assigned 12 Veterans Affairs hospital outpatient clinics to four study arms: physician-level incentive; group-level incentive; combination of physician and group incentives; and no incentives (control). All participants at the hospital (cluster) were assigned to the same study arm. We enrolled 83 full-time primary care physicians and 42 non-physician personnel. The intervention consisted of an educational session about guideline-recommended care for hypertension, five audit and feedback reports, and five disbursements of incentive payments. Incentive payments rewarded participants for chart-documented use of guideline-recommended antihypertensive medications, BP control, and appropriate responses to uncontrolled BP during a prior four-month performance period over the 20-month intervention. To identify potential unintended consequences of the incentives, the study team interviewed study participants, as well as non-participant primary care personnel and leadership at study sites. Chart reviews included data collection on quality measures not related to hypertension. To evaluate the persistence of the effect of the incentives, the study design includes a washout period.DiscussionWe briefly describe the rationale for the interventions being studied, as well as the major design choices. Rigorous research designs such as the one described here are necessary to determine whether performance-based payment arrangements such as financial incentives result in meaningful quality improvements.Trial Registrationhttp://www.clinicaltrials.govNCT00302718

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Pay-for-Performance Research

Cited by 70 publications

References 6 publications

Ethnic Disparities in Diabetes Management and Pay-for-Performance in the UK: The Wandsworth Prospective Diabetes Study

Ethnic Disparities in Diabetes Management and Pay-for-Performance in the UK: The Wandsworth Prospective Diabetes Study

Aligning provider incentives to improve primary health care delivery in the United States

Design, rationale, and baseline characteristics of a cluster randomized controlled trial of pay for performance for hypertension treatment: study protocol

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