Navathe Amol S, Volpp Kevin G, Bond Amelia M, Linn Kristin A, Caldarella Kristen L, Troxel Andrea B, Zhu Jingsan, Yang Lin, Matloubieh Shireen E, Drye Elizabeth E, Bernheim Susannah M, Oshima Lee Emily, Mugiishi Mark, Endo Kimberly Takata, Yoshimoto Justin, Emanuel Ezekiel J
Amol S. Navathe (
Kevin G. Volpp is a professor of medicine in the Department of Medicine at the Perelman School of Medicine and of health care management at the Wharton School, vice chair for health policy in the Department of Medical Ethics and Health Policy, and director of the Center for Health Incentives and Behavioral Economics, all at the University of Pennsylvania, and a staff physician at the Corporal Michael J. Crescenz VA Medical Center.
Health Aff (Millwood). 2020 May;39(5):852-861. doi: 10.1377/hlthaff.2019.01061.
Policy makers are increasingly using performance feedback that compares physicians to their peers as part of payment policy reforms. However, it is not known whether peer comparisons can improve broad outcomes, beyond changing specific individual behaviors such as reducing inappropriate prescribing of antibiotics. We conducted a cluster-randomized controlled trial with Blue Cross Blue Shield of Hawaii to examine the impact of providing peer comparisons feedback on the quality of care to primary care providers in the setting of a shift from fee-for-service to population-based payment. Over 74,000 patients and eighty-eight primary care providers across sixty-three sites were included over a period of nine months in 2016. Patients in the peer comparisons intervention group experienced a 3.1-percentage-point increase in quality scores compared to the control group-whose members received individual feedback only. This result underscores the effectiveness of peer comparisons as a way to improve health care quality, and it supports Medicare's decisions to provide comparative feedback as part of recently implemented primary care and specialty payment reform programs.
政策制定者越来越多地将医生与同行进行比较的绩效反馈用作支付政策改革的一部分。然而，除了改变特定的个体行为（如减少抗生素的不适当处方）之外，尚不清楚同行比较是否能改善广泛的结果。我们与夏威夷蓝十字蓝盾公司进行了一项整群随机对照试验，以研究在从按服务收费转向基于人群的支付模式的背景下，提供同行比较反馈对初级保健提供者医疗质量的影响。2016年的九个月期间，纳入了来自63个地点的74000多名患者和88名初级保健提供者。与仅接受个人反馈的对照组相比，同行比较干预组的患者质量得分提高了3.1个百分点。这一结果强调了同行比较作为提高医疗质量的一种方式的有效性，并支持医疗保险将提供比较反馈作为最近实施的初级保健和专科支付改革计划一部分的决定。
