Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Popul Health Manag. 2019 Jun;22(3):248-254. doi: 10.1089/pop.2018.0093. Epub 2018 Sep 11.
Public and private insurers increasingly use quality payment programs as a tool to improve quality of care in primary care settings. However, little is known about primary care providers' perspectives on whether and how quality payment programs improve diabetes quality of care. In this qualitative study, the authors conducted semi-structured interviews and focus groups with 23 providers from March to June 2015. Transcripts were analyzed to identify key themes using the immersion-crystallization method. Almost all of the providers believed that insurers play a meaningful role in improving quality of care for diabetes patients. Most thought that insurers' efforts are more effective when channeled through providers and delivery systems rather than directed at patients. Providers generally believed that quality payment programs have had a positive impact on quality of diabetes care, although provider views were not evidence based. Providers in practices in which quality payment programs were believed to have had a positive impact stated that the programs provided financial incentives and resources for improved population health management systems and additional staff. Conversely, most providers did not believe that quality payment programs have had any impact via direct financial incentives to individual physicians. A few providers were skeptical about the impact of quality payment programs and noted negative consequences that they had observed. Providers recommended strategies to improve quality payment programs (eg, refine quality measures, provide regular feedback on quality and costs) and additional strategies that insurers could consider to address provider- and patient-level barriers to high-quality diabetes care.
越来越多的公共和私人保险公司将质量支付计划用作改善初级保健环境下医疗质量的工具。然而，对于初级保健提供者对于质量支付计划是否以及如何改善糖尿病护理质量的看法，知之甚少。在这项定性研究中，作者于 2015 年 3 月至 6 月期间对 23 名提供者进行了半结构化访谈和焦点小组讨论。使用沉浸-结晶方法分析转录本以确定关键主题。几乎所有的提供者都认为保险公司在改善糖尿病患者的护理质量方面发挥了重要作用。大多数人认为，当保险公司的努力通过提供者和提供系统来引导，而不是针对患者时，效果会更有效。提供者普遍认为质量支付计划对糖尿病护理质量产生了积极影响，尽管提供者的观点没有依据。在质量支付计划被认为产生了积极影响的实践中，提供者表示，这些计划为改善人口健康管理系统和增加额外的员工提供了财务激励和资源。相反，大多数提供者认为质量支付计划并没有通过对个别医生的直接财务激励产生任何影响。一些提供者对质量支付计划的影响持怀疑态度，并指出他们观察到的负面后果。提供者建议了一些改善质量支付计划的策略（例如，改进质量措施，定期提供质量和成本反馈），以及保险公司可以考虑采取的其他策略，以解决提供者和患者层面的高质量糖尿病护理障碍。
