The effects of pay-for-performance programs on health, health care use, and processes of care: A systematic review

Aaron Mendelson, Karli Kondo, Cheryl Damberg, Allison Low, Makalapua Motuapuaka, Michele Freeman, Maya O'Neil, Rose Relevo, Devan Kansagara

Research output: Contribution to journalArticle

86 Citations (Scopus)

Abstract

Background: The benefits of pay-for-performance (P4P) programs are uncertain. Purpose: To update and expand a prior review examining the effects of P4P programs targeted at the physician, group, managerial, or institutional level on process-of-care and patient outcomes in ambulatory and inpatient settings. Data Sources: PubMed from June 2007 to October 2016; MEDLINE, PsycINFO, CINAHL, Business Economics and Theory, Business Source Elite, Scopus, Faculty of 1000, and Gartner Research from June 2007 to February 2016. Study Selection: Trials and observational studies in ambulatory and inpatient settings reporting process-of-care, health, or utilization outcomes. Data Extraction: Two investigators extracted data, assessed study quality, and graded the strength of the evidence. Data Synthesis: Among 69 studies, 58 were in ambulatory settings, 52 reported process-of-care outcomes, and 38 reported patient outcomes. Low-strength evidence suggested that P4P programs in ambulatory settings may improve process-of-care outcomes over the short term (2 to 3 years), whereas data on longer-term effects were limited. Many of the positive studies were conducted in the United Kingdom, where incentives were larger than in the United States. The largest improvements were seen in areas where baseline performance was poor. There was no consistent effect of P4P on intermediate health outcomes (low-strength evidence) and insufficient evidence to characterize any effect on patient health outcomes. In the hospital setting, there was low-strength evidence that P4P had little or no effect on patient health outcomes and a positive effect on reducing hospital readmissions. Limitation: Few methodologically rigorous studies; heterogeneous population and program characteristics and incentive targets. Conclusion: Pay-for-performance programs may be associated with improved processes of care in ambulatory settings, but consistently positive associations with improved health outcomes have not been demonstrated in any setting. Primary Funding Source: U.S. Department of Veterans Affairs.

Original languageEnglish (US)
Pages (from-to)341-353
Number of pages13
JournalAnnals of Internal Medicine
Volume166
Issue number5
DOIs
StatePublished - Mar 7 2017

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Incentive Reimbursement
Delivery of Health Care
Health
Motivation
Inpatients
Patient Acceptance of Health Care
Patient Readmission
United States Department of Veterans Affairs
Population Control
Information Storage and Retrieval
Population Characteristics
Ambulatory Care
PubMed
MEDLINE
Observational Studies
Patient Care
Economics
Research Personnel
Physicians
Research

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Mendelson, A., Kondo, K., Damberg, C., Low, A., Motuapuaka, M., Freeman, M., ... Kansagara, D. (2017). The effects of pay-for-performance programs on health, health care use, and processes of care: A systematic review. Annals of Internal Medicine, 166(5), 341-353. https://doi.org/10.7326/M16-1881

The effects of pay-for-performance programs on health, health care use, and processes of care : A systematic review. / Mendelson, Aaron; Kondo, Karli; Damberg, Cheryl; Low, Allison; Motuapuaka, Makalapua; Freeman, Michele; O'Neil, Maya; Relevo, Rose; Kansagara, Devan.

In: Annals of Internal Medicine, Vol. 166, No. 5, 07.03.2017, p. 341-353.

Research output: Contribution to journalArticle

Mendelson, A, Kondo, K, Damberg, C, Low, A, Motuapuaka, M, Freeman, M, O'Neil, M, Relevo, R & Kansagara, D 2017, 'The effects of pay-for-performance programs on health, health care use, and processes of care: A systematic review', Annals of Internal Medicine, vol. 166, no. 5, pp. 341-353. https://doi.org/10.7326/M16-1881
Mendelson, Aaron ; Kondo, Karli ; Damberg, Cheryl ; Low, Allison ; Motuapuaka, Makalapua ; Freeman, Michele ; O'Neil, Maya ; Relevo, Rose ; Kansagara, Devan. / The effects of pay-for-performance programs on health, health care use, and processes of care : A systematic review. In: Annals of Internal Medicine. 2017 ; Vol. 166, No. 5. pp. 341-353.
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