Do Performance Incentives Improve Healthcare Quality for Vulnerable Populations?

美国医疗保健面临着一项艰巨的挑战-提高质量和消除差距，同时 控制成本。许多医生、政策制定者和雇主乐观地认为，绩效激励 -以绩效工资和公开报道的形式-将有助于提高美国人的质量 医疗保健。尽管这些项目激增，但几乎没有证据表明它们产生了 预期的结果，重要的数据表明，它们可能会造成负面的意外后果。 在本研究方案中，我们假设绩效激励可以显著提高激励效果 医疗保健的组成部分，但将对没有激励的保健组成部分产生无效或负面影响。至 检查这些问题，我们将使用回溯性研究设计，并在三个月内抽取独立样本 在引入绩效激励前后及时战略性地选择横截面 全国最大的具有联邦资质的健康中心，Access社区健康网络。帮助说明 在干预前后的设计中无法解决的长期趋势，我们将比较 在研究期间提供的护理变化对患者总体病例组合趋势的影响 句号。 拟议的研究将对医疗质量和公平领域作出新的贡献，因为 以及关于激励的一般文献。它将发展我们的方法来经验地评估 组织干预的有意和无意影响，提供对惩罚效果的洞察 绩效激励计划，产生关于医生级激励效果的基础信息。 并首次对绩效激励在社区卫生中的使用进行了严格的实证评估 居中设置。 这一调查领域的理想候选人必须表现出在服务不足方面的能力和经验 利用跨学科资源的社区、临床医学和与政策相关的研究。 钱博士就是那个候选人--她在与弱势群体打交道方面有丰富的实践经验。 是一名执业的普通儿科医生，也是罗伯特·伍德·约翰逊临床学者协会最近的校友 具有研究记录的计划，利用医学、公共政策和 经济学。 这一职业发展奖对钱博士进一步发展技能和经验至关重要 有必要成为全国受人尊敬的卫生服务研究员，研究与政策相关的问题 与在医疗保健中使用绩效激励有关，特别是与提供给 少数群体、复杂医学群体和社会弱势群体。

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.