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Pay-for-performance challenges in family physician program.

ABSTRACT: Objective:This study was conducted to investigate the challenges faced in the implementation of the pay-for-performance system in Iran's family physician program. Study design:Qualitative. Place and duration of study:The study was conducted with 32 key informants at the family physician program at the Tabriz University of Medical Sciences between May 2018 and June 2018. Method: This is a qualitative study. A purposeful sampling method was used with only one inclusion criterion for participants: five years of experience in the family physician program. The researchers conducted 17 individual and group non-structured interviews and examined participants' perspectives on the challenges faced in the implementation of the pay-for-performance system in the family physician program. Content analysis was conducted on the obtained data. Results:This study identified 7 themes, 14 sub-themes, and 46 items related to the challenges in the implementation of pay-for-performance systems in Iran's family physician program. The main themes are: workload, training, program cultivation, payment, assessment and monitoring, information management, and level of authority. Other sub-challenges were also identified. Conclusion:The study results demonstrate some notable challenges faced in the implementation of the pay-for-performance system. This information can be helpful to managers and policymakers.

SUBMITTER: Gharibi F

PROVIDER: S-EPMC7430307 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Pay-for-performance challenges in family physician program.

Gharibi F F Dadgar E E

Malaysian family physician : the official journal of the Academy of Family Physicians of Malaysia 20200706 2

<h4>Objective</h4>This study was conducted to investigate the challenges faced in the implementation of the pay-for-performance system in Iran's family physician program.<h4>Study design</h4>Qualitative.<h4>Place and duration of study</h4>The study was conducted with 32 key informants at the family physician program at the Tabriz University of Medical Sciences between May 2018 and June 2018. <b>Method:</b> This is a qualitative study. A purposeful sampling method was used with only one inclusion ...[more]

PMID: 32843941

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Project description:To determine the impact of the Hospital Value-Based Purchasing (HVBP) program-the US pay for performance program introduced by Medicare to incentivize higher quality care-on 30 day mortality for three incentivized conditions: acute myocardial infarction, heart failure, and pneumonia.Observational study.4267 acute care hospitals in the United States: 2919 participated in the HVBP program and 1348 were ineligible and used as controls (44 in general hospitals in Maryland and 1304 critical access hospitals across the United States).2?430?618 patients admitted to US hospitals from 2008 through 2013.30 day risk adjusted mortality for acute myocardial infarction, heart failure, and pneumonia using a patient level linear spline analysis to examine the association between the introduction of the HVBP program and 30 day mortality. Non-incentivized, medical conditions were the comparators. A secondary outcome measure was to determine whether the introduction of the HVBP program was particularly beneficial for a subgroup of hospital-poor performers at baseline-that may benefit the most.Mortality rates of incentivized conditions in hospitals participating in the HVBP program declined at -0.13% for each quarter during the preintervention period and -0.03% point difference for each quarter during the post-intervention period. For non-HVBP hospitals, mortality rates declined at -0.14% point difference for each quarter during the preintervention period and -0.01% point difference for each quarter during the post-intervention period. The difference in the mortality trends between the two groups was small and non-significant (difference in difference in trends -0.03% point difference for each quarter, 95% confidence interval -0.08% to 0.13% point difference, P=0.35). In no subgroups of hospitals was HVBP associated with better outcomes, including poor performers at baseline.Evidence that HVBP has led to lower mortality rates is lacking. Nations considering similar pay for performance programs may want to consider alternative models to achieve improved patient outcomes.

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Pay-for-performance challenges in family physician program.

Publications

Pay-for-performance challenges in family physician program.

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