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Improving the quality of primary care by allocating performance-based targets, in a diverse insured population

BACKGROUND: Primary Care Health organizations, operating under universal coverage and a regulated package of benefits, compete mainly over quality of care. Monitoring, primary care clinical performance, has been repeatedly proven effective in improving the quality of care. In 2004, Maccabi Healthcar...

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Autores principales: Peled, Ronit, Porath, Avi, Wilf-Miron, Rachel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5117594/
https://www.ncbi.nlm.nih.gov/pubmed/27871283
http://dx.doi.org/10.1186/s12913-016-1920-6
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author Peled, Ronit
Porath, Avi
Wilf-Miron, Rachel
author_facet Peled, Ronit
Porath, Avi
Wilf-Miron, Rachel
author_sort Peled, Ronit
collection PubMed
description BACKGROUND: Primary Care Health organizations, operating under universal coverage and a regulated package of benefits, compete mainly over quality of care. Monitoring, primary care clinical performance, has been repeatedly proven effective in improving the quality of care. In 2004, Maccabi Healthcare Services (MHS), the second largest Israeli HMO, launched its Performance Measurement System (PMS) based on clinical quality indicators. A unique module was built in the PMS to adjust for case mix while tailoring targets to the local units. This article presents the concept and formulas developed to adjust targets to the units’ current performance, and analyze change in clinical indicators over a six year period, between sub-population groups. METHODS: Six process and intermediate outcome indicators, representing screening for breast and colorectal cancer and care for patients with diabetes and cardiovascular disease, were selected and analyzed for change over time (2003–2009) in overall performance, as well as the difference between the lowest and the highest socio-economic ranks (SERs) and Arab and non-Arab members. RESULTS: MHS demonstrated a significant improvement in the selected indicators over the years. Performance of members from low SERs and Arabs improved to a greater extent, as compared to members from high ranks and non-Arabs, respectively. CONCLUSION: The performance measurement system, with its module for tailoring of units' targets, served as a managerial vehicle for bridging existing gaps by allocating more resources to lower performing units. This concept was proven effective in improving performance while reducing disparities between diverse population groups.
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spelling pubmed-51175942016-11-28 Improving the quality of primary care by allocating performance-based targets, in a diverse insured population Peled, Ronit Porath, Avi Wilf-Miron, Rachel BMC Health Serv Res Research Article BACKGROUND: Primary Care Health organizations, operating under universal coverage and a regulated package of benefits, compete mainly over quality of care. Monitoring, primary care clinical performance, has been repeatedly proven effective in improving the quality of care. In 2004, Maccabi Healthcare Services (MHS), the second largest Israeli HMO, launched its Performance Measurement System (PMS) based on clinical quality indicators. A unique module was built in the PMS to adjust for case mix while tailoring targets to the local units. This article presents the concept and formulas developed to adjust targets to the units’ current performance, and analyze change in clinical indicators over a six year period, between sub-population groups. METHODS: Six process and intermediate outcome indicators, representing screening for breast and colorectal cancer and care for patients with diabetes and cardiovascular disease, were selected and analyzed for change over time (2003–2009) in overall performance, as well as the difference between the lowest and the highest socio-economic ranks (SERs) and Arab and non-Arab members. RESULTS: MHS demonstrated a significant improvement in the selected indicators over the years. Performance of members from low SERs and Arabs improved to a greater extent, as compared to members from high ranks and non-Arabs, respectively. CONCLUSION: The performance measurement system, with its module for tailoring of units' targets, served as a managerial vehicle for bridging existing gaps by allocating more resources to lower performing units. This concept was proven effective in improving performance while reducing disparities between diverse population groups. BioMed Central 2016-11-21 /pmc/articles/PMC5117594/ /pubmed/27871283 http://dx.doi.org/10.1186/s12913-016-1920-6 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Peled, Ronit
Porath, Avi
Wilf-Miron, Rachel
Improving the quality of primary care by allocating performance-based targets, in a diverse insured population
title Improving the quality of primary care by allocating performance-based targets, in a diverse insured population
title_full Improving the quality of primary care by allocating performance-based targets, in a diverse insured population
title_fullStr Improving the quality of primary care by allocating performance-based targets, in a diverse insured population
title_full_unstemmed Improving the quality of primary care by allocating performance-based targets, in a diverse insured population
title_short Improving the quality of primary care by allocating performance-based targets, in a diverse insured population
title_sort improving the quality of primary care by allocating performance-based targets, in a diverse insured population
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5117594/
https://www.ncbi.nlm.nih.gov/pubmed/27871283
http://dx.doi.org/10.1186/s12913-016-1920-6
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