Effect of Financial Incentives on Improvement in Medical Quality Indicators for Primary Care
Effect of Financial Incentives on Improvement in Medical Quality Indicators for Primary Care
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DOI：
10.3122/jabfm.2010.05.070187
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发表时间：
2010-09-01
影响因子：
2.9
通讯作者：
Goodrick, G. Ken
中科院分区：
文献类型：
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作者：
Gavagan, Thomas F.;Du, Hongyan;Goodrick, G. Ken
目的：对提供预防服务的医生进行经济奖励的有效性尚未得到证实。本研究的目的是评估一个医生按业绩付费计划的效果类似于医疗保险医生质量报告倡议计划的预防保健质量在网络的社区health centers.Methods：一个回顾性的行政数据进行了审查，以评估一个自然的准实验在网络的公共资助的初级保健诊所。11个诊所中有6个诊所的医生获得了两倍于目前医疗保险和医疗补助服务中心奖励的经济奖励，以实现预防保健的群体目标，包括宫颈癌筛查，乳房X光检查和儿科免疫接种。他们还获得了生产力激励。六年的绩效指标之间进行了比较激励和nonincentivized诊所。我们还调查了激励的临床医生对他们的看法的激励program.Results：虽然一些性能指标提高了所有的措施和所有的诊所，有激励和那些没有临床显着差异的诊所。巴氏涂片的线性趋势检验接近常规显著性水平（P = .08），但与观察到的非线性变化相比，其幅度非常适中;没有提示乳腺X线摄影或儿科免疫接种呈线性趋势。调查显示，大多数医生认为，激励措施是不是很有效，在提高quality of care.Conclusion：我们发现没有证据表明，在这些社区卫生中心的预防保健性能的经济激励措施的临床显着效果。根据我们的研究结果和其他研究结果，我们认为非常需要进行更多的研究，并进行强有力的研究设计，以确定财政激励对初级保健临床质量指标的积极和消极影响。（J Am Board Fam Med 2010; 23：622-631.）
Purpose: The efficacy of rewarding physicians financially for preventive services is unproven. The objective of this study was to evaluate the effect of a physician pay-for-performance program similar to the Medicare Physician Quality Reporting Initiative program on quality of preventive care in a network of community health centers.Methods: A retrospective review of administrative data was done to evaluate a natural quasi-experiment in a network of publicly funded primary care clinics. Physicians in 6 of 11 clinics were given a financial incentive twice the size of the current Centers for Medicare and Medicaid Services' incentive for achieving group targets in preventive care that included cervical cancer screening, mammography, and pediatric immunization. They also received productivity incentives. Six years of performance indicators were compared between incentivized and nonincentivized clinics. We also surveyed the incentivized clinicians about their perception of the incentive program.Results: Although some performance indicators improved for all measures and all clinics, there were no clinically significant differences between clinics that had incentives and those that did not. A linear trend test approached conventional significance levels for Papanicolaou smears (P = .08) but was of very modest magnitude compared with observed nonlinear variations; there was no suggestion of a linear trend for mammography or pediatric immunizations. The survey revealed that most physicians felt the incentives were not very effective in improving quality of care.Conclusion: We found no evidence for a clinically significant effect of financial incentives on performance of preventive care in these community health centers. Based on our findings and others, we believe there is great need for more research with strong research designs to determine the effects, both positive and negative, of financial incentives on clinical quality indicators in primary care. (J Am Board Fam Med 2010; 23: 622-631.)