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Real-time Feedback in Pay-for-Performance: Does More Information Lead to Improvement?

ABSTRACT: BACKGROUND:Pay-for-performance (P4P) has been used expansively to improve quality of care delivered by physicians. However, to what extent P4P works through the provision of information versus financial incentives is poorly understood. OBJECTIVE:To determine whether an increase in information feedback without changes to financial incentives resulted in improved physician performance within an existing P4P program. INTERVENTION/EXPOSURE:Implementation of a new registry enabling real-time feedback to physicians on quality measure performance. DESIGN:Observational, predictive piecewise model at the physician-measure level to examine whether registry introduction associated with performance changes. We used detailed physician quality measure data 3 years prior to registry implementation (2010-2012) and 2 years after implementation (2014-2015). We also linked physician-level data including age, gender, and board certification; group-level data including registry click rates; and patient panel data including chronic conditions. PARTICIPANTS:Four hundred thirty-four physicians continuously affiliated with Advocate from 2010 to 2015. MAIN MEASURES:Physician performance on ten quality metrics. KEY RESULTS:We found no consistent pattern of improvement associated with the availability of real-time information across ten measures. Relative to predicted performance without the registry, average performance increased for two measures (childhood immunization status-rotavirus (p?

SUBMITTER: Bond AM

PROVIDER: S-EPMC6712150 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Real-time Feedback in Pay-for-Performance: Does More Information Lead to Improvement?

Bond Amelia M AM Volpp Kevin G KG Emanuel Ezekiel J EJ Caldarella Kristen K Hodlofski Amanda A Sacks Lee L Patel Pankaj P Sokol Kara K Vittore Salvatore S Calgano Don D Nelson Carrie C Weng Kevin K Troxel Andrea A Navathe Amol A

Journal of general internal medicine 20190430 9

<h4>Background</h4>Pay-for-performance (P4P) has been used expansively to improve quality of care delivered by physicians. However, to what extent P4P works through the provision of information versus financial incentives is poorly understood.<h4>Objective</h4>To determine whether an increase in information feedback without changes to financial incentives resulted in improved physician performance within an existing P4P program.<h4>Intervention/exposure</h4>Implementation of a new registry enabl ...[more]

PMID: 31041590

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Project description:BackgroundAlthough pay-for-performance (P4P) has become a central strategy for improving quality in US healthcare, questions persist about the effectiveness of these programs. A key question is whether quality improvement that occurs as a result of P4P programs is sustainable, particularly if incentives are removed.ObjectiveTo investigate sustainability of performance levels following removal of performance-based incentives.Design, setting, and participantsObservational cohort study that capitalized on a P4P program within the Veterans Health Administration (VA) that included adoption and subsequent removal of performance-based incentives for selected inpatient quality measures. The study sample comprised 128 acute care VA hospitals where performance was assessed between 2004 and 2010.InterventionVA system managers set annual performance goals in consultation with clinical leaders, and report performance scores to medical centers on a quarterly basis. These scores inform performance-based incentives for facilities and their managers. Bonuses are distributed based on the attainment of these performance goals.MeasurementsSeven quality of care measures for acute coronary syndrome, heart failure, and pneumonia linked to performance-based incentives.ResultsSignificant improvements in performance were observed for six of seven quality of care measures following adoption of performance-based incentives and were maintained up to the removal of the incentive; subsequently, the observed performance levels were sustained.LimitationsThis is a quasi-experimental study without a comparison group; causal conclusions are limited.ConclusionThe maintenance of performance levels after removal of a performance-based incentive has implications for the implementation of Medicare's value-based purchasing initiative and other P4P programs. Additional research is needed to better understand human and system-level factors that mediate sustainability of performance-based incentives.

Project description:ImportanceHand hygiene adherence monitoring and feedback can reduce health care-acquired infections in hospitals. Few low-cost hand hygiene adherence monitoring tools exist in low-resource settings.ObjectiveTo pilot an open-source application for mobile devices and an interactive analytical dashboard for the collection and visualization of health care workers' hand hygiene adherence data.Design, setting, and participantsThis prospective multicenter quality improvement study evaluated preintervention and postintervention adherence with the 5 Moments for Hand Hygiene, as suggested by the World Health Organization, among health care workers from April 23 to May 25, 2018. A novel data collection form, the Hand Hygiene Observation Tool, was developed in open-source software and used to measure adherence with hand hygiene guidelines among health care workers in the inpatient therapeutic feeding center and pediatric ward of Anka General Hospital, Anka, Nigeria, and the postoperative ward of Noma Children's Hospital, Sokoto, Nigeria. Qualitative data were analyzed throughout data collection and used for immediate feedback to staff. A more formal analysis of the data was conducted during October 2018.ExposuresMultimodal hand hygiene improvement strategy with increased availability and accessibility of alcohol-based hand sanitizer, staff training and education, and evaluation and feedback in near real-time.Main outcomes and measuresHand hygiene adherence before and after the intervention in 3 hospital wards, stratified by health care worker role, ward, and moment of hand hygiene.ResultsA total of 686 preintervention adherence observations and 673 postintervention adherence observations were conducted. After the intervention, overall hand hygiene adherence increased from 32.4% to 57.4%. Adherence increased in both wards in Anka General Hospital (inpatient therapeutic feeding center, 24.3% [54 of 222 moments] to 63.7% [163 of 256 moments]; P < .001; pediatric ward, 50.9% [132 of 259 moments] to 68.8% [135 of 196 moments]; P < .001). Adherence among nurses in Anka General Hospital also increased in both wards (inpatient therapeutic feeding center, 17.7% [28 of 158 moments] to 71.2% [79 of 111 moments]; P < .001; pediatric ward, 45.9% [68 of 148 moments] to 68.4% [78 of 114 moments]; P < .001). In Noma Children's Hospital, the overall adherence increased from 17.6% (36 of 205 moments) to 39.8% (88 of 221 moments) (P < .001). Adherence among nurses in Noma Children's Hospital increased from 11.5% (14 of 122 moments) to 61.4% (78 of 126 moments) (P < .001). Adherence among Noma Children's Hospital physicians decreased from 34.2% (13 of 38 moments) to 8.6% (7 of 81 moments). Lowest overall adherence after the intervention occurred before patient contact (53.1% [85 of 160 moments]), before aseptic procedure (58.3% [21 of 36 moments]), and after touching a patient's surroundings (47.1% [124 of 263 moments]).Conclusions and relevanceThis study suggests that tools for the collection and rapid visualization of hand hygiene adherence data are feasible in low-resource settings. The novel tool used in this study may contribute to comprehensive infection prevention and control strategies and strengthening of hand hygiene behavior among all health care workers in health care facilities in humanitarian and low-resource settings.

Project description:BackgroundRunning technique and running speed are considered important risk factors for running injuries. Real-time feedback on running technique and running speed by wearables may help reduce injury risk.PurposeTo investigate whether real-time feedback on spatiotemporal metrics and relative speed by commercially available pressure-sensitive insoles would reduce running injuries and improve running performance compared with no real-time feedback.Study designRandomized controlled trial; Level of evidence, 1.MethodsA total of 220 recreational runners were randomly assigned into the intervention and control groups. Both groups received pressure-sensitive insoles, but only the intervention group received real-time feedback on spatiotemporal metrics and relative speed. The feedback aimed to reduce loading on the joint/segment estimated to exhibit the highest load. Injury rates were compared between the groups using Cox regressions. Secondary outcomes compared included injury severity, the proportion of runners with multiple injuries, changes in self-reported personal best times and motivation (Behavioral Regulation in Exercise Questionnaire-2), and interest in continuing wearable use after study completion.ResultsA total of 160 participants (73%) were included in analyses of the primary outcome. Intention-to-treat analysis showed no significant difference in injury rate between the groups (Hazard ratio [HR], 1.11; P = .70). This was expected, as 53 of 160 (33%) participants ended up in the unassigned group because they used incorrect wearable settings, nullifying any interventional effects. As-treated analysis showed a significantly lower injury rate among participants receiving real-time feedback (HR, 0.53; P = .03). Similarly, the first-time injury severity was significantly lower (-0.43; P = .042). Per-protocol analysis showed no significant differences in injury rates, but the direction favored the intervention group (HR, 0.67; P = .30). There were no significant differences in the proportion of patients with multiple injuries (HR, 0.82; P = .40) or changes in running performance (3.07%; P = .26) and motivation. Also, ~60% of the participants who completed the study showed interest in continuing wearable use.ConclusionReal-time feedback on spatiotemporal metrics and relative speed provided by commercially available instrumented insoles may reduce the rate and severity of injuries in recreational runners. Feedback did not influence running performance and exercise motivation.RegistrationNL8472 (Dutch Trial Register).

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Real-time Feedback in Pay-for-Performance: Does More Information Lead to Improvement?

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Real-time Feedback in Pay-for-Performance: Does More Information Lead to Improvement?

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