Provider Attitudes Associated With Adherence to Evidence-Based Clinical Guidelines in a Managed Care Setting

Waddimba, Anthony C.; Meterko, Mark; Beckman, Howard; Young, Gary J.; Burgess, James

doi:10.1177/1077558709342882

Cited by 14 publications

(21 citation statements)

References 50 publications

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“…We identified one prospective cohort, 9 two retrospective cohort, 10,11 and one pre-post study, 12 six cross-sectional surveys, [13][14][15][16][17] one economic analysis, 18 and two simulation studies. 19,20 Related to measure development, studies found that an emphasis on clinical quality and patient experience criteria was related to increased coordination of care, improved office staff interaction, and provider confidence in providing highquality care.…”

Section: Program Design Features (13 Studies)mentioning

confidence: 99%

“…10 Similarly, another study found that after controlling for covariates, perceived financial salience was significantly related to a high degree of performance. 13 Another study found that the underlying payment structure influenced performance, and that higher incentives may be necessary when the degree of cost sharing is lower. 9 Finally, a study examining the relationship between P4P and patient experience in California over a 3-year period found that, compared with larger incentives (>10%), smaller incentives were associated with greater improvement in provider communication and office staff interaction measures.…”

Section: Program Design Features (13 Studies)mentioning

confidence: 99%

“…13,49 Studies examining the influence of provider characteristics found no strong evidence that provider characteristics (e.g., gender, age) related to performance in P4P programs. 13,29,34,43,45 …”

Section: Provider Characteristics (5 Studies)mentioning

confidence: 99%

“…Thirteen studies [9][10][11][12][13][14][15][16][17][18][19][20]50 examined program design features and found:…”

Section: Program Design Featuresmentioning

confidence: 99%

“…Provider characteristics Five studies 13,29,34,43,49 examined characteristics of the individuals involved, and provided no strong evidence that provider characteristics such as gender, experience, or specialty play a role in P4P program success.…”

Section: Implementation Processesmentioning

confidence: 99%

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Implementation Processes and Pay for Performance in Healthcare: A Systematic Review

et al. 2016

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BACKGROUND: Over the last decade, various pay-forperformance (P4P) programs have been implemented to improve quality in health systems, including the VHA. P4P programs are complex, and their effects may vary by design, context, and other implementation processes. We conducted a systematic review and key informant (KI) interviews to better understand the implementation factors that modify the effectiveness of P4P. METHODS: We searched PubMed, PsycINFO, and CINAHL through April 2014, and reviewed reference lists. We included trials and observational studies of P4P implementation. Two investigators abstracted data and assessed study quality. We interviewed P4P researchers to gain further insight. RESULTS: Among 1363 titles and abstracts, we selected 509 for full-text review, and included 41 primary studies. Of these 41 studies, 33 examined P4P programs in ambulatory settings, 7 targeted hospitals, and 1 study applied to nursing homes. Related to implementation, 13 studies examined program design, 8 examined implementation processes, 6 the outer setting, 18 the inner setting, and 5 provider characteristics. Results suggest the importance of considering underlying payment models and using statistically stringent methods of composite measure development, and ensuring that high-quality care will be maintained after incentive removal. We found no conclusive evidence that provider or practice characteristics relate to P4P effectiveness. Interviews with 14 KIs supported limited evidence that effective P4P program measures should be aligned with organizational goals, that incentive structures should be carefully considered, and that factors such as a strong infrastructure and public reporting may have a large influence. DISCUSSION: There is limited evidence from which to draw firm conclusions related to P4P implementation. Findings from studies and KI interviews suggest that P4P programs should undergo regular evaluation and should target areas of poor performance. Additionally, measures and incentives should align with organizational priorities, and programs should allow for changes over time in response to data and provider input.

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