TY - JOUR
T1 - The effects of pay-for-performance programs on health, health care use, and processes of care
T2 - A systematic review
AU - Mendelson, Aaron
AU - Kondo, Karli
AU - Damberg, Cheryl
AU - Low, Allison
AU - Motuapuaka, Makalapua
AU - Freeman, Michele
AU - O'Neil, Maya
AU - Relevo, Rose
AU - Kansagara, Devan
N1 - Funding Information:
By the U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative, Evidencebased Synthesis Program (project 05-225).
Publisher Copyright:
© 2017 American College of Physicians.
PY - 2017/3/7
Y1 - 2017/3/7
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85019115729&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85019115729&partnerID=8YFLogxK
U2 - 10.7326/M16-1881
DO - 10.7326/M16-1881
M3 - Article
C2 - 28114600
AN - SCOPUS:85019115729
SN - 0003-4819
VL - 166
SP - 341
EP - 353
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 5
ER -