按服务付费的 PPO 方案对糖尿病患者的影响。

The effect of a PPO pay-for-performance program on patients with diabetes.

机构信息

Health Benchmarks, Inc, IMS Health, 21650 Oxnard St, Ste 550, Woodland Hills, CA 91367, USA.

出版信息

Am J Manag Care. 2010 Jan 1;16(1):e11-9.

PMID:20059287

Abstract

OBJECTIVES

To investigate the effectiveness of a pay-for-performance program (P4P) to increase the receipt of quality care and to decrease hospitalization rates among patients with diabetes mellitus.

STUDY DESIGN

Longitudinal study of patients with diabetes enrolled in a preferred provider organization (PPO) between January 1, 1999, and December 31, 2006.

METHODS

We used multivariate analyses to assess the effect of seeing P4P-participating physicians on the receipt of quality care (ie, glycosylated hemoglobin and low-density lipoprotein cholesterol testing) and on hospitalization rates, controlling for patient characteristics.

RESULTS

Patients with diabetes who saw P4P-participating physicians were more likely to receive quality care than those who did not (odds ratio, 1.16; 95% confidence interval, 1.11-1.22; P <.001). Patients with diabetes who received quality care were less likely to be hospitalized than those who did not (incident rate ratio, 0.80; 95% confidence interval, 0.80-0.85; P <.001). During 1 year, there was no difference in hospitalization rates between patients with diabetes who saw P4P-participating physicians versus those who did not. However, patients with diabetes who saw P4P-participating physicians in 3 consecutive years were less likely to be hospitalized than those who did not (incident rate ratio, 0.75; 95% confidence interval, 0.61-0.93; P <.01).

CONCLUSIONS

A P4P can significantly increase the receipt of quality care and decrease hospitalization rates among patients with diabetes in a PPO setting. Although it is possible that the differences observed between P4P-participating physicians and non-P4P-participating physicians were due to selection bias, we found no significant difference in the receipt of quality care between patients with diabetes who saw new P4P-participating physicians versus non-P4P-participating physicians during the baseline year. Further research should focus on defining the effect of P4Ps on intermediate outcomes such as glycosylated hemoglobin and low-density lipoprotein cholesterol levels.

摘要

目的

调查按绩效付费方案（P4P）在提高糖尿病患者获得优质护理的效果，并降低其住院率。

研究设计

1999 年 1 月 1 日至 2006 年 12 月 31 日期间，对参加优选医疗组织（PPO）的糖尿病患者进行的纵向研究。

方法

我们使用多元分析来评估患者看 P4P 参与医生对接受质量护理（即糖化血红蛋白和低密度脂蛋白胆固醇检测）和住院率的影响，同时控制患者特征。

结果

与不看 P4P 参与医生的患者相比，看 P4P 参与医生的糖尿病患者更有可能获得优质护理（优势比，1.16；95%置信区间，1.11-1.22；P<.001）。接受优质护理的糖尿病患者比未接受的患者住院可能性更低（发病率比，0.80；95%置信区间，0.80-0.85；P<.001）。在 1 年内，看 P4P 参与医生的糖尿病患者与不看的患者住院率没有差异。然而，连续 3 年看 P4P 参与医生的糖尿病患者住院可能性低于不看的患者（发病率比，0.75；95%置信区间，0.61-0.93；P<.01）。

结论

在 PPO 环境中，P4P 可显著提高糖尿病患者获得优质护理的效果，并降低其住院率。尽管观察到的 P4P 参与医生和非 P4P 参与医生之间的差异可能是由于选择偏差所致，但我们在基线年内未发现糖尿病患者看新的 P4P 参与医生与非 P4P 参与医生之间在获得优质护理方面的显著差异。进一步的研究应集中于定义 P4P 对中间结果（如糖化血红蛋白和低密度脂蛋白胆固醇水平）的影响。