Department of Public Health, Weill Cornell Medical College, New York, NY 10021, USA.
Am J Manag Care. 2012 Apr 1;18(4):e126-34.
To determine the prevalence of physician incentives for quality and to test the hypothesis that the quality of ambulatory medical care is better when provided by physicians with these incentives.
Cross-sectional study using data from the National Ambulatory Medical Care Survey.
We examined the association between 12 measures of high-quality ambulatory care and physician compensation based on quality, physician compensation based on satisfaction, and public reporting of quality measures.
Overall, 20.8% of visits were to physicians whose compensation was partially based on quality, 17.7% of visits were to physicians whose compensation was partially based on patient satisfaction, and 10.0% of visits were to physicians who publicly reported quality measures. Quality of ambulatory care varied: weight reduction counseling occurred in 12.0% of preventive care visits by obese patients, whereas no urinalysis in patients with no indication was achieved in 93.0% of preventive care visits. In multivariable analyses, there were no statistically significant associations between compensation for quality and delivery of any of the 12 measures, nor between compensation for satisfaction and 11 of the 12 measures; the exception was body mass index screening in preventive visits (47.8% vs 56.2%, adjusted P = .004). There was also no statistically significant association between public reporting and delivery of 11 of 12 measures; the exception was weight reduction counseling for overweight patients (10.0% vs 25.5%, adjusted P = .01).
We found no consistent association between incentives for quality and 12 measures of high-quality ambulatory care.
确定医生质量激励措施的流行程度，并检验这样一种假设，即当医生具有这些激励措施时，门诊医疗质量会更好。
使用国家门诊医疗调查数据进行的横断面研究。
我们检查了 12 项高质量门诊护理措施与基于质量的医生薪酬之间的关联、基于患者满意度的医生薪酬之间的关联以及质量措施的公开报告。
总体而言，20.8%的就诊是由部分基于质量的薪酬补偿的医生提供的，17.7%的就诊是由部分基于患者满意度的薪酬补偿的医生提供的，10.0%的就诊是由公开报告质量措施的医生提供的。门诊护理质量存在差异：肥胖患者的预防保健就诊中，有 12.0%接受了减重咨询，而在没有指征的预防保健就诊中，没有进行任何尿分析，这一比例达到了 93.0%。在多变量分析中，质量补偿与 12 项措施中的任何一项的提供之间没有统计学上显著的关联，满意度补偿与 11 项措施中的任何一项之间也没有关联；但预防就诊中的体重指数筛查除外（47.8%比 56.2%，调整后的 P =.004）。公开报告与 12 项措施中的 11 项措施的提供之间也没有统计学上显著的关联；但超重患者的减重咨询除外（10.0%比 25.5%，调整后的 P =.01）。
我们没有发现质量激励措施与 12 项高质量门诊护理措施之间存在一致的关联。
