Benzer Justin K, Young Gary J, Burgess James F, Baker Errol, Mohr David C, Charns Martin P, Kaboli Peter J
Center for Organization, Leadership, and Management Research (COLMR) at the VA Boston Healthcare System (152 M), 150 South Huntington Avenue, Boston, MA, 02860, USA,
J Gen Intern Med. 2014 Jan;29(1):127-32. doi: 10.1007/s11606-013-2572-4. Epub 2013 Aug 9.
Although pay-for-performance (P4P) has become a central strategy for improving quality in US healthcare, questions persist about the effectiveness of these programs. A key question is whether quality improvement that occurs as a result of P4P programs is sustainable, particularly if incentives are removed.
To investigate sustainability of performance levels following removal of performance-based incentives.
DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study that capitalized on a P4P program within the Veterans Health Administration (VA) that included adoption and subsequent removal of performance-based incentives for selected inpatient quality measures. The study sample comprised 128 acute care VA hospitals where performance was assessed between 2004 and 2010.
VA system managers set annual performance goals in consultation with clinical leaders, and report performance scores to medical centers on a quarterly basis. These scores inform performance-based incentives for facilities and their managers. Bonuses are distributed based on the attainment of these performance goals.
Seven quality of care measures for acute coronary syndrome, heart failure, and pneumonia linked to performance-based incentives.
Significant improvements in performance were observed for six of seven quality of care measures following adoption of performance-based incentives and were maintained up to the removal of the incentive; subsequently, the observed performance levels were sustained.
This is a quasi-experimental study without a comparison group; causal conclusions are limited.
The maintenance of performance levels after removal of a performance-based incentive has implications for the implementation of Medicare's value-based purchasing initiative and other P4P programs. Additional research is needed to better understand human and system-level factors that mediate sustainability of performance-based incentives.
尽管按绩效付费（P4P）已成为美国医疗保健领域提高质量的核心策略，但这些项目的有效性仍存在疑问。一个关键问题是，P4P项目带来的质量改进是否可持续，尤其是在激励措施取消之后。
调查取消基于绩效的激励措施后绩效水平的可持续性。
设计、背景和参与者：观察性队列研究，利用退伍军人健康管理局（VA）内部的一个P4P项目，该项目包括采用并随后取消对选定住院患者质量指标的基于绩效的激励措施。研究样本包括128家急性护理VA医院，在2004年至2010年期间对其绩效进行评估。
VA系统管理人员与临床领导协商设定年度绩效目标，并每季度向医疗中心报告绩效得分。这些得分用于为机构及其管理人员提供基于绩效的激励。奖金根据这些绩效目标的达成情况进行分配。
与基于绩效的激励措施相关的急性冠状动脉综合征、心力衰竭和肺炎的七项护理质量指标。
在采用基于绩效的激励措施后，七项护理质量指标中的六项出现了显著的绩效改善，并在激励措施取消前一直保持；随后，观察到的绩效水平得以维持。
这是一项没有对照组的准实验研究；因果结论有限。
取消基于绩效的激励措施后绩效水平的维持，对医疗保险基于价值的采购计划及其他P4P项目的实施具有启示意义。需要进行更多研究，以更好地理解影响基于绩效的激励措施可持续性的人为因素和系统层面因素。
