Association Between the Implementation of a Population-Based Primary Care Payment System and Achievement on Quality Measures in Hawaii
Association Between the Implementation of a Population-Based Primary Care Payment System and Achievement on Quality Measures in Hawaii
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DOI：
10.1001/jama.2019.8113
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发表时间：
2019-07-02
影响因子：
120.7
通讯作者：
Volpp, Kevin G.
中科院分区：
文献类型：
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作者：
Navathe, Amol S.;Emanuel, Ezekiel J.;Volpp, Kevin G.
夏威夷医疗服务协会（HMSA），夏威夷蓝十字蓝盾，于2016年推出了基于人口的初级保健支付（3PC），这是一种新的基于资本的初级保健支付系统。该系统对质量措施的影响尚未得到评价。目的评估3PC系统在第一年是否与质量、利用率或支出的变化有关。设计、设置和参与者观察性研究，使用2012年1月1日至2016年12月31日的HMSA声明和临床注册数据。采用倾向加权差分法，比较夏威夷的77 225名HMSA成员归因于107名初级保健医生（pcp）和4个参与第一批3PC的医生组织，以及222 233名成员归因于312名pcp和14个医生组织，这些组织在2016年继续采用按服务收费模式，但此后有3PC开始日期。参与第三方系统。主要结果和测量主要结果是综合测量得分的变化，反映了成员在13个合并的医疗保健有效性数据和信息集质量测量中达到合格测量的可能性。初级保健就诊和总护理费用是15个次要结果之一。结果共纳入299458名HMSA成员（平均年龄42.1岁，女性占51.5%）和419名初级保健医生（平均年龄54.9岁，女性占34.8%）。2012年至2016年，风险标准化综合措施得分在3PC组从75.1%变化到86.6%（+ 11.5个百分点），在非3PC组从74.3%变化到83.5%（+ 9.2个百分点）(差异变化，2.3个百分点[95% CI， 2.1至2.6个百分点]
IMPORTANCE Hawaii Medical Service Association (HMSA), the Blue Cross Blue Shield of Hawaii, introduced Population-based Payments for Primary Care (3PC), a new capitation-based primary care payment system, in 2016. The effect of this system on quality measures has not been evaluated.OBJECTIVE To evaluate whether the 3PC system was associated with changes in quality, utilization, or spending in its first year.DESIGN, SETTING, AND PARTICIPANTS Observational study using HMSA claims and clinical registry data from January 1, 2012, to December 31, 2016, and a propensity-weighted difference-in-differencesmethod to compare 77 225 HMSA members in Hawaii attributed to 107 primary care physicians (PCPs) and 4 physician organizations participating in the first wave of the 3PC and 222 233 members attributed to 312 PCPs and 14 physician organizations that continued in a fee-for-service model in 2016 but had 3PC start dates thereafter.EXPOSURES Participation in the 3PC system.MAIN OUTCOMES AND MEASURES The primary outcome was the change in a composite measure score reflecting the probability that a member achieved an eligible measure out of 13 pooled Healthcare Effectiveness Data and Information Set quality measures. Primary care visits and total cost of care were among 15 secondary outcomes.RESULTS In total, the study included 299 458 HMSA members (mean age, 42.1 years; 51.5% women) and 419 primary care physicians (mean age, 54.9 years; 34.8% women). The risk-standardized composite measure scores for 2012 to 2016 changed from 75.1% to 86.6% (+ 11.5 percentage points) in the 3PC group and 74.3% to 83.5%(+ 9.2 percentage points) in the non-3PC group (differential change, 2.3 percentage points [95% CI, 2.1 to 2.6 percentage points]; P