The Long-Term Effect of Premier Pay for Performance on Patient Outcomes
The Long-Term Effect of Premier Pay for Performance on Patient Outcomes
复制标题
DOI：
10.1056/nejmsa1112351
复制
发表时间：
2012-04-26
影响因子：
158.5
通讯作者：
Epstein, Arnold M.
中科院分区：
文献类型：
--
作者：
Jha, Ashish K.;Joynt, Karen E.;Epstein, Arnold M.
背景绩效工资已成为推动改善医疗保健的核心战略。我们评估了医疗保险总理医院质量激励示范（HQID）对患者outcomes.MethodsWe使用医疗保险的数据比较结果之间的252家医院参加总理HQID和3363控制医院参加公开报告。我们研究了2003年至2009年间600多万例急性心肌梗死、充血性心力衰竭、肺炎或接受冠状动脉旁路移植术（CABG）的患者的30天死亡率。结果在基线时，高级医院和非高级医院的复合30天死亡率相似（分别为12.33%和12.40%;差异，-0.07个百分点; 95%置信区间[CI]，-0.40至0.26）。两类医院每季度死亡率的下降率也相似（分别为0.04%和0.04%;差异，-0.01个百分点; 95%CI，-0.02至0.01），在绩效工资制度下，6年后死亡率保持相似（高级医院为11.82%，非高级医院为11.74%;差异为0.08个百分点; 95%CI为-0.30至0.46）。我们发现，绩效薪酬对死亡率的影响在结果与激励明确相关的条件（急性心肌梗死和CABG）和与激励无关的条件（充血性心力衰竭和肺炎）之间没有显著差异（相互作用P=0.36）。在基线时表现不佳的医院中，研究开始时两组医院的死亡率相似（15.12%和14.73%;差异，0.39个百分点; 95% CI，-0.36至1.15），每个季度的改善率相似（0.10%和0.07%;差异，-0.03个百分点; 95% CI，-0.08至0.02），研究结束时的死亡率相似（13.37%和13.21%;差异，0.15个百分点; 95%CI，-0.70至1.01）。ConclusionsWe发现没有证据表明，最大的医院为基础的绩效工资计划导致30天死亡率下降。因此，对以Premier HQID为模型的计划的改进结果的期望应该保持适度。
BackgroundPay for performance has become a central strategy in the drive to improve health care. We assessed the long-term effect of the Medicare Premier Hospital Quality Incentive Demonstration (HQID) on patient outcomes.MethodsWe used Medicare data to compare outcomes between the 252 hospitals participating in the Premier HQID and 3363 control hospitals participating in public reporting alone. We examined 30-day mortality among more than 6 million patients who had acute myocardial infarction, congestive heart failure, or pneumonia or who underwent coronary-artery bypass grafting (CABG) between 2003 and 2009.ResultsAt baseline, the composite 30-day mortality was similar for Premier and non-Premier hospitals (12.33% and 12.40%, respectively; difference, -0.07 percentage points; 95% confidence interval [CI], -0.40 to 0.26). The rates of decline in mortality per quarter at the two types of hospitals were also similar (0.04% and 0.04%, respectively; difference, -0.01 percentage points; 95% CI, -0.02 to 0.01), and mortality remained similar after 6 years under the pay-for-performance system (11.82% for Premier hospitals and 11.74% for non-Premier hospitals; difference, 0.08 percentage points; 95% CI, -0.30 to 0.46). We found that the effects of pay for performance on mortality did not differ significantly among conditions for which outcomes were explicitly linked to incentives (acute myocardial infarction and CABG) and among conditions not linked to incentives (congestive heart failure and pneumonia) (P=0.36 for interaction). Among hospitals that were poor performers at baseline, mortality was similar in the two groups of hospitals at the start of the study (15.12% and 14.73%; difference, 0.39 percentage points; 95% CI, -0.36 to 1.15), with similar rates of improvement per quarter (0.10% and 0.07%; difference, -0.03 percentage points; 95% CI, -0.08 to 0.02) and similar mortality rates at the end of the study (13.37% and 13.21%; difference, 0.15 percentage points; 95% CI, -0.70 to 1.01).ConclusionsWe found no evidence that the largest hospital-based pay-for-performance program led to a decrease in 30-day mortality. Expectations of improved outcomes for programs modeled after Premier HQID should therefore remain modest.