Beaulieu Nancy Dean, Horrigan Dennis R
Harvard Business School, Mellon Hall A4-5, Soldiers Field, Boston, MA 02163, USA.
Health Serv Res. 2005 Oct;40(5 Pt 1):1318-34. doi: 10.1111/j.1475-6773.2005.00414.x.
To investigate the effects of paying physicians for performance on quality measures of diabetes care when combined with other care management tools.
DATA SOURCES/STUDY SETTING: In 2001, a managed care organization in upstate New York designed and implemented a pilot program to financially reward doctors for the quality of care delivered to diabetic patients. In addition to paying a performance bonus, physicians were also supplied with a diabetic registry and met in groups to discuss progress in meeting goals for diabetic care. Primary data on diabetes care at the patient level were collected from each physician during the 8-month period, April 2001-January 2002.
Physicians were scored on individual process and outcome measures of diabetes care on three separate occasions; these individual scores were combined into a composite score on which the financial reward was allocated. The study design is pre/post for the patients whose physicians participated in the performance pay program. The control group is a large sample of the health plan's diabetic members.
Data on patient outcomes were self-reported by physicians participating in the study. These data were audited with spot checks of medical charts. Data for the control group were collected as part of the health plan's annual HEDIS data collection.
Physicians and patients achieved significant improvement on five out of six process measures, and on two out of three outcome measures (HbA1c control and LDL control). Thirteen out of 21 physicians improved their average composite score enough to earn some level of financial reward. Of the eight physicians not receiving any of the three levels of reward, six improved their composite scores.
Financial incentives for physicians, bundled with other care management tools, led to improvement on objectively measured quality of care for diabetic patients. Self-selection by physicians into the pay pilot and the small sample size of participating physicians limit the generalizability of the results.
研究在与其他护理管理工具相结合时，对医生进行绩效薪酬激励对糖尿病护理质量指标的影响。
数据来源/研究背景：2001年，纽约州北部的一家管理式医疗组织设计并实施了一项试点项目，根据为糖尿病患者提供的护理质量对医生进行经济奖励。除了支付绩效奖金外，还为医生提供糖尿病患者登记册，并组织小组会议讨论糖尿病护理目标的达成进展。在2001年4月至2002年1月的8个月期间，从每位医生处收集了患者层面的糖尿病护理原始数据。
在三个不同时间点，根据糖尿病护理的个体过程和结果指标对医生进行评分；这些个体评分被合并为一个综合评分，据此分配经济奖励。对于医生参与绩效薪酬项目的患者，研究设计为前后对照。对照组是该健康计划中大量的糖尿病成员样本。
参与研究的医生自行报告患者的结果数据。这些数据通过抽查病历进行审核。对照组的数据作为健康计划年度医疗效果数据信息集（HEDIS）数据收集的一部分进行收集。
在六项过程指标中的五项以及三项结果指标中的两项（糖化血红蛋白[HbA1c]控制和低密度脂蛋白[LDL]控制）上，医生和患者都取得了显著改善。21名医生中有13名提高了他们的平均综合评分，足以获得一定程度的经济奖励。在未获得三个奖励级别中任何一个的八名医生中，有六名提高了他们的综合评分。
对医生的经济激励与其他护理管理工具相结合，使得糖尿病患者客观测量的护理质量得到了改善。医生自行选择参与薪酬试点以及参与医生的样本量较小，限制了研究结果的普遍性。
