Do Performance Incentives Improve Healthcare Quality for Vulnerable Populations?

美国医疗保健面临着一个艰巨的挑战-提高质量，消除差距， 包含成本。许多医生、政策制定者和雇主对绩效激励持乐观态度， - 以绩效工资和公开报告的形式，将有助于提高美国的质量。 健康护理尽管这些程序的扩散，很少有证据表明，他们产生的 然而，有大量数据表明，它们可能会产生意想不到的负面后果。 在本研究建议中，我们假设绩效激励可以显著提高激励 这将对保健的非激励性组成部分产生无效或负面影响。到 为了研究这些问题，我们将采用回顾性研究设计，并在三个月内抽取独立样本， 战略选择的横截面在时间之前和之后的业绩激励措施，在我们的 全国最大的联邦合格的健康中心，访问社区健康网络。来帮助解释 长期趋势，否则不能在干预前和干预后的设计，我们将比较 研究期间ACCESS中患者总体病例组合趋势的护理变化 期 这项拟议的研究将为医疗质量和公平性领域做出新的贡献， 以及关于激励的一般文献。它将发展我们的方法， 组织干预措施的预期和非预期影响，提供了对惩罚效果的深入了解， 绩效激励计划，产出关于医生层面激励效果的基础信息。 并成为第一个严格的实证评估的使用绩效激励在社区卫生 中心设置。 这一调查线的理想候选人必须表现出能力和经验不足， 社区，临床医学和政策相关的研究，利用跨学科资源。 博士简就是这样的候选人--她有着丰富的与弱势群体打交道的经验。 是一名执业的全科儿科医生，是罗伯特伍德约翰逊临床学者的最近校友 该计划与研究的跟踪记录，借鉴了医学，公共政策和 经济学 这个职业发展奖对钱博士进一步发展技能和经验至关重要。 必须成为一个全国受人尊敬的卫生服务研究人员谁检查政策相关的问题 与在医疗保健中使用绩效激励有关，特别是因为它涉及到向 少数民族、医疗综合体和社会弱势群体。

American healthcare faces a difficult challenge - improve quality and eliminate disparities while containing costs. Many physicians, policymakers and employers are optimistic that performance incentives - in the form of pay-for-performance and public reporting -- will help improve the quality of American healthcare. Despite the proliferation of these programs, there is little evidence that they produce their intended results, and significant data suggests that they can create negative unintended consequences. In this study proposal, we hypothesize that performance incentives can significantly improve incentivized components of care, but will have a null or negative effect on unincentivized components of care. To examine these questions, we will use a retrospective study design and draw independent samples at three strategically chosen cross-sections in time before and after the introduction of performance incentives at our nation's largest federally-qualified health center, ACCESS Community Health Network. To help account for secular trends that cannot otherwise be addressed in a pre- and post-intervention design, we will compare changes in the care provided to trends in the overall case-mix of patients at ACCESS during the study period. The proposed study will provide a novel contribution to the fields of healthcare quality and equity, as well as to the general literature on incentives. It will develop our methods for empirically evaluating the intended and unintended impact of organizational interventions, provide insight into the effect of penalties in performance incentive programs, yield foundational information on the effect of physician-level incentives. and be the first rigorous empirical evaluation of the use of performance incentives in the Community Health Center setting. The ideal candidate for this line of inquiry must demonstrate aptitude and experience in underserved communities, clinical medicine, and policy-relevant research that draws on interdisciplinary resources. Dr. Chien is that candidate - she has extensive 'hands on' experience working with vulnerable populations. is a practicing general pediatrician, and is a recent alumnus of the Robert Wood Johnson Clinical Scholars program with a track record of research that draws upon the disciplines of medicine, public policy and economics. This career development award is critical for Dr. Chien to further develop the skills and experience necessary to become a nationally respected health services researcher who examines policy-relevant issues related to the use of performance incentives in healthcare, particularly as it pertains to the care delivered to minorities, the medically complex, and the socially disadvantaged.