Locke Robert G, Srinivasan Malathi
Neonatalogy, MAP-1 Suite 217, 4745 Ogletown-Stanton Rds, Newark, DE 19713-2074.
J Am Osteopath Assoc. 2008 Jan;108(1):21-4.
Pay-for-performance (P4P) programs reward physicians who meet-and electronically document-specific healthcare standards during patient encounters, incentivizing certain aspects of medical care. Although such documentation can be time consuming and technology intensive, noncompliance can result in decreased physician reimbursement.
To assess the attitudes of primary care osteopathic physicians toward P4P initiatives.
In 2006, a 20-item questionnaire was mailed to 1000 osteopathic physicians randomly pulled from the American Osteopathic Association database for this cross-sectional, survey-based study. Distinctions were not made between physician practice type or group size when the mailing list was compiled.
Two hundred thirty responses were received for a response rate of 23%. Of these respondents, 123 physicians (54%) were in primary care practices comprising fewer than five physicians. Of these practitioners, 94% felt unprepared for P4P initiatives, 81% did not have the resources for appropriate technological investments, and 75% required additional P4P education and training to respond to P4P initiatives. In addition, the 28% of respondents who used electronic medical records were almost five times more likely (odds ratio, 4.80; 95% confidence interval, 1.91-12.06) to report that they could meet P4P reporting requirements. The majority of survey respondents were skeptical that P4P would appropriately capture the quality of their work and did not believe that health outcomes should influence their reimbursement.
Although the current study's sample size may limit generalizability, small group primary care osteopathic physicians will need assistance-both technological and educational-to meet P4P measures.
按绩效付费（P4P）项目会奖励那些在患者诊疗过程中达到并以电子方式记录特定医疗标准的医生，以此激励医疗护理的某些方面。尽管这种记录可能既耗时又需要大量技术投入，但不遵守规定可能会导致医生报销减少。
评估整骨疗法初级保健医生对P4P举措的态度。
2006年，一份包含20个条目的问卷被邮寄给从美国整骨疗法协会数据库中随机抽取的1000名整骨疗法医生，用于这项基于调查的横断面研究。编制邮件列表时未区分医生的执业类型或团体规模。
共收到230份回复，回复率为23%。在这些受访者中，123名医生（54%）从事的是初级保健工作，所在医疗团队少于5名医生。在这些从业者中，94%觉得自己对P4P举措没有做好准备，81%没有资源进行适当的技术投资，75%需要额外的P4P教育和培训来应对P4P举措。此外，使用电子病历的28%的受访者报告称他们能够满足P4P报告要求的可能性几乎是其他人的五倍（优势比，4.80；95%置信区间，1.91 - 12.06）。大多数调查受访者怀疑P4P能否恰当地体现他们的工作质量，并且不认为健康结果应影响他们的报销。
尽管当前研究的样本量可能会限制其普遍性，但小型团体的整骨疗法初级保健医生将需要技术和教育方面的帮助，以满足P4P标准。
