Research Institute, Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA 94301, USA.
Am J Manag Care. 2010 Feb 1;16(2):e35-42.
To assess the effect of a physician-specific pay-for-performance program on quality-of-care measures in a large group practice.
In 2007, Palo Alto Medical Clinic, a multispecialty physician group practice, changed from group-focused to physician-specific pay-for-performance incentives. Primary care physicians received incentive payments based on their quarterly assessed performance.
We examined 9 reported and incentivized clinical outcome and process measures. Five reported and nonincentivized measures were used for comparison purposes. The quality score of each physician for each measure was the main dependent variable and was calculated as follows: Quality Score = (Patients Meeting Target / Eligible Patients) x 100. Differences in scores between 2006 and 2007 were compared with differences in scores between 2005 and 2006. We also compared the performance of Palo Alto Medical Clinic with that of 2 other affiliated physician groups implementing group-level incentives.
Eight of 9 reported and incentivized measures showed significant improvement in 2007 compared with 2006. Three measures showed an improvement trend significantly better than the previous year's trend. A similar improvement trend was observed in 1 related measure that was reported but was nonincentivized. However, the improvement trend of Palo Alto Medical Clinic was not consistently different from that of the other 2 physician groups.
Small financial incentives (maximum, $5000/year) based on individual physicians' performance may have led to continued or enhanced improvement in well-established ambulatory care measures. Compared with other quality improvement programs having alternative foci for incentives (eg, increasing support for staff hours), the effect of physician-specific incentives was not evident.
评估医师专项绩效付费计划对大型执业医师集团医疗质量措施的影响。
2007 年，帕洛阿尔托医疗诊所（Palo Alto Medical Clinic），一个多专科执业医师集团，从以团体为中心转变为以医师为中心的绩效付费激励模式。初级保健医生根据他们的季度评估表现获得激励性报酬。
我们研究了 9 项报告和激励性临床结果和流程措施。5 项报告和非激励性措施被用于比较目的。每位医生每项措施的质量评分是主要的因变量，计算方法如下：质量评分=（达标患者/合格患者）x100。2007 年与 2006 年之间的评分差异与 2005 年与 2006 年之间的评分差异进行了比较。我们还比较了帕洛阿尔托医疗诊所与另外 2 个实施团体水平激励的附属医师集团的表现。
在 2007 年，9 项报告和激励性措施中有 8 项与 2006 年相比有显著改善。其中 3 项措施的改善趋势明显优于前一年。1 项相关报告但非激励性措施也观察到类似的改善趋势。然而，帕洛阿尔托医疗诊所的改善趋势与其他 2 个医师集团并不一致。
基于个体医生表现的小财务激励（最高每年 5000 美元）可能导致既定的门诊护理措施持续或增强改善。与其他以激励为重点的替代方案（例如，增加对员工时间的支持）的质量改进计划相比，医师专项激励的效果并不明显。
