ABSTRACT
This article presents the results of an exploratory case study that assessed a multistakeholder alliance's initiative to motivate quality improvement in primary care physician (PCP) practices. The initiative utilized a "pay-for participation" strategy that provided incentives to PCPs to participate in the National Committee for Quality Assurance's Diabetes Physician Recognition Program (DPRP). The intervention took place over a 2-year period in 8 practices with large safety-net populations located in the Rochester, New York area. The outcomes of interest were receipt of DPRP recognition and performance on DPRP measurements by the practices, as well as qualitative information regarding practice decisions about quality improvement. Of 79 physicians who participated, 37 (47%) received DPRP recognition. Receipt of recognition was likely the result of a combination of preexisting performance and improvements in processes made during the project. While sample size prevented hypothesis testing, size of practice was unrelated to receipt of DPRP recognition. All practices with an electronic medical record and a patient registry achieved recognition. Strong physician leadership and the presence of a quality improvement infrastructure were believed to be associated with DPRP recognition. The majority of practices cited the program's honorarium and other incentives as key motivators for participation. Our findings suggest that pay-for-participation may be a viable strategy to promote quality improvement in physician practices. However, absent continuing reinforcement, it is uncertain if such programs can lead to sustained quality improvement activities.
