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The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators
Objective To evaluate the effect of financial incentives on four clinical quality indicators common to pay for performance plans in the United Kingdom and at Kaiser Permanente in California. Design Longitudinal analysis. Setting 35 medical facilities of Kaiser Permanente Northern California, 1997-20...
Autores principales: | , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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BMJ Publishing Group Ltd.
2010
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868163/ https://www.ncbi.nlm.nih.gov/pubmed/20460330 http://dx.doi.org/10.1136/bmj.c1898 |
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author | Lester, Helen Schmittdiel, Julie Selby, Joe Fireman, Bruce Campbell, Stephen Lee, Janelle Whippy, Alan Madvig, Philip |
author_facet | Lester, Helen Schmittdiel, Julie Selby, Joe Fireman, Bruce Campbell, Stephen Lee, Janelle Whippy, Alan Madvig, Philip |
author_sort | Lester, Helen |
collection | PubMed |
description | Objective To evaluate the effect of financial incentives on four clinical quality indicators common to pay for performance plans in the United Kingdom and at Kaiser Permanente in California. Design Longitudinal analysis. Setting 35 medical facilities of Kaiser Permanente Northern California, 1997-2007. Participants 2 523 659 adult members of Kaiser Permanente Northern California. Main outcomes measures Yearly assessment of patient level glycaemic control (HbA(1c) <8%), screening for diabetic retinopathy, control of hypertension (systolic blood pressure <140 mm Hg), and screening for cervical cancer. Results Incentives for two indicators—screening for diabetic retinopathy and for cervical cancer—were removed during the study period. During the five consecutive years when financial incentives were attached to screening for diabetic retinopathy (1999-2003), the rate rose from 84.9% to 88.1%. This was followed by four years without incentives when the rate fell year on year to 80.5%. During the two initial years when financial incentives were attached to cervical cancer screening (1999-2000), the screening rate rose slightly, from 77.4% to 78.0%. During the next five years when financial incentives were removed, screening rates fell year on year to 74.3%. Incentives were then reattached for two years (2006-7) and screening rates began to increase. Across the 35 facilities, the removal of incentives was associated with a decrease in performance of about 3% per year on average for screening for diabetic retinopathy and about 1.6% per year for cervical cancer screening. Conclusion Policy makers and clinicians should be aware that removing facility directed financial incentives from clinical indicators may mean that performance levels decline. |
format | Text |
id | pubmed-2868163 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | BMJ Publishing Group Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-28681632010-05-18 The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators Lester, Helen Schmittdiel, Julie Selby, Joe Fireman, Bruce Campbell, Stephen Lee, Janelle Whippy, Alan Madvig, Philip BMJ Research Objective To evaluate the effect of financial incentives on four clinical quality indicators common to pay for performance plans in the United Kingdom and at Kaiser Permanente in California. Design Longitudinal analysis. Setting 35 medical facilities of Kaiser Permanente Northern California, 1997-2007. Participants 2 523 659 adult members of Kaiser Permanente Northern California. Main outcomes measures Yearly assessment of patient level glycaemic control (HbA(1c) <8%), screening for diabetic retinopathy, control of hypertension (systolic blood pressure <140 mm Hg), and screening for cervical cancer. Results Incentives for two indicators—screening for diabetic retinopathy and for cervical cancer—were removed during the study period. During the five consecutive years when financial incentives were attached to screening for diabetic retinopathy (1999-2003), the rate rose from 84.9% to 88.1%. This was followed by four years without incentives when the rate fell year on year to 80.5%. During the two initial years when financial incentives were attached to cervical cancer screening (1999-2000), the screening rate rose slightly, from 77.4% to 78.0%. During the next five years when financial incentives were removed, screening rates fell year on year to 74.3%. Incentives were then reattached for two years (2006-7) and screening rates began to increase. Across the 35 facilities, the removal of incentives was associated with a decrease in performance of about 3% per year on average for screening for diabetic retinopathy and about 1.6% per year for cervical cancer screening. Conclusion Policy makers and clinicians should be aware that removing facility directed financial incentives from clinical indicators may mean that performance levels decline. BMJ Publishing Group Ltd. 2010-05-11 /pmc/articles/PMC2868163/ /pubmed/20460330 http://dx.doi.org/10.1136/bmj.c1898 Text en © Lester et al 2010 This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode. |
spellingShingle | Research Lester, Helen Schmittdiel, Julie Selby, Joe Fireman, Bruce Campbell, Stephen Lee, Janelle Whippy, Alan Madvig, Philip The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators |
title | The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators |
title_full | The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators |
title_fullStr | The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators |
title_full_unstemmed | The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators |
title_short | The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators |
title_sort | impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four kaiser permanente indicators |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868163/ https://www.ncbi.nlm.nih.gov/pubmed/20460330 http://dx.doi.org/10.1136/bmj.c1898 |
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