Early experience with pay-for-performance - From concept to practice
Early experience with pay-for-performance - From concept to practice
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DOI：
10.1001/jama.294.14.1788
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发表时间：
2005-10-12
影响因子：
120.7
通讯作者：
Epstein, AM
中科院分区：
文献类型：
--
作者：
Rosenthal, MB;Frank, RG;Epstein, AM
背景 为提高质量而采用按绩效付费的机制正在迅速增长。尽管人们对按绩效付费计划抱有浓厚的兴趣和乐观态度，但很少有关于医疗保健中按绩效付费的研究发表。 目的 评估原型医生按绩效付费计划对护理质量的影响。 设计、设置和参与者 我们使用来自干预组（加利福尼亚医生组）和同期对照组（太平洋西北医生组）的大型健康计划的医生组质量管理报告来评估按绩效付费的自然实验。质量改进报告包括从 2001 年 10 月到 2004 年 4 月向大约 300 个大型医师组织发布的质量改进报告。 主要结果指标 临床质量的三项流程指标：宫颈癌筛查、乳房 X 光检查和血红蛋白 A(1c) 检测。结果 临床质量评分的改进如下：对于宫颈癌筛查，加利福尼亚州提高了 5.3%，太平洋西北地区提高了 1.7%；对于乳房 X 光检查，1.9% vs 0.2%；对于血红蛋白 A(1c)，分别为 2.1% 和 2.1%。与太平洋西北地区的医生群体相比，加州网络仅在宫颈癌筛查方面进行按绩效付费干预后，质量得到了更大的改善（改善差异为 3.6% [P=0.02]）。 2003 年 7 月至 2004 年 4 月（该计划第一年）期间，该计划总共发放了 340 万美元（预留金额的 27%）奖金。对于所有 3 项衡量标准，基线绩效达到或高于领取奖金绩效阈值的医生群体改善最少，但获得的奖金份额最大。 结论 向临床医生支付费用以实现共同的、固定的绩效目标可能不会对所花的资金产生质量上的提升，而会在很大程度上奖励那些基线绩效较高的医生。
Context The adoption of pay-for-performance mechanisms for quality improvement is growing rapidly. Although there is intense interest in and optimism about pay-for-performance programs, there is little published research on pay-for-performance in health care.Objective To evaluate the impact of a prototypical physician pay-for-performance program on quality of care.Design, Setting, and Participants We evaluated a natural experiment with pay-for-performance using administrative reports of physician group quality from a large health plan for an intervention group (California physician groups) and a contemporaneous comparison group (Pacific Northwest physician groups). Quality improvement reports were included from October 2001 through April 2004 issued to approximately 300 large physician organizations.Main Outcome Measures Three process measures of clinical quality: cervical cancer screening, mammography, and hemoglobin A(1c) testing.Results Improvements in clinical quality scores were as follows: for cervical cancer screening, 5.3% for California vs 1.7% for Pacific Northwest; for mammography, 1.9% vs 0.2%; and for hemoglobin A(1c), 2.1% vs 2.1%. Compared with physician groups in the Pacific Northwest, the California network demonstrated greater quality improvement after the pay-for-performance intervention only in cervical cancer screening (a 3.6% difference in improvement [P=.02]). In total, the plan awarded $3.4 million (27% of the amount set aside) in bonus payments between July 2003 and April 2004, the first year of the program. For all 3 measures, physician groups with baseline performance at or above the performance threshold for receipt of a bonus improved the least but garnered the largest share of the bonus payments.Conclusion Paying clinicians to reach a common, fixed performance target may produce little gain in quality for the money spent and will largely reward those with higher performance at baseline.