Evaluating a Pay-for-Performance Program for Medicaid Children in an Accountable Care Organization
Evaluating a Pay-for-Performance Program for Medicaid Children in an Accountable Care Organization
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DOI：
10.1001/jamapediatrics.2015.3809
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发表时间：
2016-03-01
期刊：
影响因子：
26.1
通讯作者：
Gardner, William
中科院分区：
文献类型：
--
作者：
Gleeson, Sean;Kelleher, Kelly;Gardner, William
绩效工资（P4P）是一种机制，通过这种机制，医疗保健的购买者为改善护理过程或结果的医生提供更大的经济奖励。据我们所知，P4P还没有研究的背景下，儿科责任护理组织（ACO）。目的要确定是否P4P促进儿科性能的改善，在primary care physics.DESIGN，设置，和参与者这项回顾性队列研究进行了2010年1月1日至2013年12月31日。差异中的差异设计被用来测试是否P4P提高医生的表现在ACO服务医疗补助儿童。数据来自2966名医生和323812名患者。确定了三组医生：（1）接受P4P激励的社区医生，（2）非激励社区医生，（3）在医院工作的非激励医生。干预按绩效付费。主要结果和衡量标准医疗保健有效性数据信息设定预防性护理、慢性病护理和急症护理初级保健服务的衡量标准。我们检查了21个质量措施，其中14个受到P4P incentives.RESULTS有203激励医生，2590 nonincentivized医生，和173 nonincentivized医院医生。其中，受激励的社区医生在2/2的油井访视中的表现比未受激励的社区医生有更大的改善（最大的差异是青少年良好护理：比值比，1.05; 99.88% CI，1.02-1.08），10项免疫激励措施中的3项（最大差异是灭活脊髓灰质炎疫苗：比值比，1.14; 99.88% CI，1.07-1.21），和2个非激励措施（最大差异是轮状病毒：比值比，1.11; 99.88% CI，1.04-1.18）。在14项激励措施中的8项和7项非激励措施中的1项上，医院雇用的医生组的绩效比激励的社区医生有更大的改善（最大的差异是甲型肝炎疫苗：比值比，0.34; 99.88%CI，0.31-0.37）。结论和相关性绩效薪酬导致儿科ACO中医生绩效的适度变化，但助理法律顾问办公室所采取的其他干预措施可能更为有效。需要进一步的研究来找到方法，以提高大型分布式儿科卫生系统的质量改进。
IMPORTANCE Pay for performance (P4P) is a mechanism by which purchasers of health care offer greater financial rewards to physicians for improving processes or outcomes of care. To our knowledge, P4P has not been studied within the context of a pediatric accountable care organization (ACO).OBJECTIVE To determine whether P4P promotes pediatric performance improvement in primary care physicians.DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted from January 1, 2010, to December 31, 2013. A differences-in-differences design was used to test whether P4P improved physician performance in an ACO serving Medicaid children. Data were obtained from 2966 physicians and 323 812 patients. Three groups of physicians were identified: (1) community physicians who received the P4P incentives, (2) nonincentivized community physicians, and (3) nonincentivized physicians employed at a hospital. INTERVENTION Pay for performance.MAIN OUTCOMES AND MEASURES Healthcare Effectiveness Data Information Set measure rates for preventive care, chronic care, and acute care primary care services. We examined 21 quality measures, 14 of which were subject to P4P incentives.RESULTS There were 203 incentivized physicians, 2590 nonincentivized physicians, and 173 nonincentivized hospital physicians. Among them, the incentivized community physicians had greater improvements in performance than the nonincentivized community physicians on 2 of 2 well visits (largest difference was for adolescent well care: odds ratio, 1.05; 99.88% CI, 1.02-1.08), 3 of 10 immunization-incentivized measures (largest difference was for inactivated polio vaccine: odds ratio, 1.14; 99.88% CI, 1.07-1.21), and 2 nonincentivized measures (largest difference was for rotavirus: odds ratio, 1.11; 99.88% CI, 1.04-1.18). The employed physician group at the hospital had greater improvements in performance than the incentivized community physicians on 8 of 14 incentivized measures and 1 of 7 nonincentivized measures (largest difference was for hepatitis A vaccine: odds ratio, 0.34; 99.88% CI, 0.31-0.37).CONCLUSIONS AND RELEVANCE Pay for performance resulted in modest changes in physician performance in a pediatric ACO, but other interventions at the disposal of the ACO may have been even more effective. Further research is required to find methods to enhance quality improvements across large distributed pediatric health systems.