West Side Community Health Services, Inc., 895 E 7th St., Saint Paul, MN, 55106, USA.
Family and Community Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, PO Box 26509, Milwaukee, WI, 53226, USA.
Int J Equity Health. 2018 Nov 7;17(1):161. doi: 10.1186/s12939-018-0872-3.
Quality metrics, pay for performance (P4P), and value-based payments are prominent aspects of the current and future American healthcare system. However, linking clinic payment to clinic quality measures may financially disadvantage safety-net clinics and their patient population because safety-net clinics often have worse quality metric scores than non-safety net clinics. The Minnesota Safety Net Coalition's Quality Measurement Enhancement Project sought to collect data from primary care providers' (PCPs) experiences, which could assist Minnesota policymakers and state agencies as they create a new P4P system. Our research study aims are to identify PCPs' perspectives about 1) quality metrics at safety net clinics and non-safety net clinics, 2) how clinic quality measures affect patients and patient care, and 3) how payment for quality measures may influence healthcare.
Qualitative interviews with 14 PCPs (4 individual interviews and 3 focus groups) who had worked at both safety net and non-safety net primary care clinics in Minneapolis-St Paul Minnesota USA metropolitan area. Qualitative analyses identified major themes.
Three themes with sub-themes emerged. Theme #1: Minnesota's current clinic quality scores are influenced more by patients and clinic systems than by clinicians. Theme #2: Collecting data for a set of specific quality measures is not the same as measuring quality healthcare. Subtheme #2.1: Current quality measures are not aligned with how patients and clinicians define quality healthcare. Theme #3: Current quality measures are a product of and embedded in social and structural inequities in the American health care system. Subtheme #3.1: The current inequitable healthcare system should not be reinforced with financial payments. Subtheme #3.2: Health equity requires new metrics and a new healthcare system. Overall, PCPs felt that the current inequitable quality metrics should be replaced by different metrics along with major changes to the healthcare system that could produce greater health equity.
Aligning payment with the current quality metrics could perpetuate and exacerbate social inequities and health disparities. Policymakers should consider PCPs' perspectives and create a quality-payment framework that does not disadvantage patients who are affected by social and structural inequities as well as the clinics and providers who serve them.
质量指标、按绩效付费（P4P）和基于价值的支付是当前和未来美国医疗保健系统的突出方面。然而，将诊所支付与诊所质量措施联系起来可能会使医疗保障诊所及其患者群体处于财务劣势，因为保障医疗诊所的质量指标评分往往比非保障医疗诊所差。明尼苏达州保障医疗联盟的质量测量增强项目旨在收集初级保健提供者（PCP）的经验数据，这将有助于明尼苏达州政策制定者和州机构在创建新的 P4P 系统时提供参考。我们的研究目的是确定 PCP 对以下方面的看法：1）保障医疗诊所和非保障医疗诊所的质量指标，2）诊所质量措施如何影响患者和患者护理，以及 3）质量措施的支付方式如何影响医疗保健。
对在美国明尼苏达州明尼阿波利斯-圣保罗大都市区工作过保障医疗和非保障医疗初级保健诊所的 14 名 PCP 进行了定性访谈（4 次个人访谈和 3 次焦点小组）。定性分析确定了主要主题。
出现了三个主题和三个子主题。主题 1：明尼苏达州目前的诊所质量评分更多地受到患者和诊所系统的影响，而不是临床医生的影响。主题 2：收集一套特定质量措施的数据与衡量优质医疗保健并不相同。子主题 2.1：当前的质量措施与患者和临床医生对优质医疗保健的定义不一致。主题 3：当前的质量措施是美国医疗保健系统中社会和结构性不平等的产物，并嵌入其中。子主题 3.1：当前不平等的医疗保健系统不应通过经济支付来加强。子主题 3.2：健康公平需要新的指标和新的医疗保健系统。总体而言，PCP 认为，目前不平等的质量指标应该用不同的指标来取代，同时对医疗保健系统进行重大改革，以实现更大的健康公平。
将支付与当前的质量指标挂钩可能会延续和加剧社会不平等和健康差距。政策制定者应考虑 PCP 的观点，并创建一个不使受社会和结构性不平等影响的患者以及为他们服务的诊所和提供者处于不利地位的质量支付框架。
