The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators.
| Autor: | Lester H; NIHR School for Primary Care Research, Manchester M13 9PL. Helen.lester@manchester.ac.uk, Schmittdiel J, Selby J, Fireman B, Campbell S, Lee J, Whippy A, Madvig P |
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| Jazyk: | angličtina |
| Zdroj: | BMJ (Clinical research ed.) [BMJ] 2010 May 11; Vol. 340, pp. c1898. Date of Electronic Publication: 2010 May 11. |
| DOI: | 10.1136/bmj.c1898 |
| Abstrakt: | Objective: To evaluate the effect of financial incentives on four clinical quality indicators common to pay for performance plans in the United Kingdom and at Kaiser Permanente in California. Design: Longitudinal analysis. Setting: 35 medical facilities of Kaiser Permanente Northern California, 1997-2007. Participants: 2 523 659 adult members of Kaiser Permanente Northern California. Main outcomes measures Yearly assessment of patient level glycaemic control (HbA(1c) <8%), screening for diabetic retinopathy, control of hypertension (systolic blood pressure <140 mm Hg), and screening for cervical cancer. Results: Incentives for two indicators-screening for diabetic retinopathy and for cervical cancer-were removed during the study period. During the five consecutive years when financial incentives were attached to screening for diabetic retinopathy (1999-2003), the rate rose from 84.9% to 88.1%. This was followed by four years without incentives when the rate fell year on year to 80.5%. During the two initial years when financial incentives were attached to cervical cancer screening (1999-2000), the screening rate rose slightly, from 77.4% to 78.0%. During the next five years when financial incentives were removed, screening rates fell year on year to 74.3%. Incentives were then reattached for two years (2006-7) and screening rates began to increase. Across the 35 facilities, the removal of incentives was associated with a decrease in performance of about 3% per year on average for screening for diabetic retinopathy and about 1.6% per year for cervical cancer screening. Conclusion: Policy makers and clinicians should be aware that removing facility directed financial incentives from clinical indicators may mean that performance levels decline. |
| Databáze: | MEDLINE |
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