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Am J Manag Care ; 16(1): e11-9, 2010 Jan 01.
Article in English | MEDLINE | ID: mdl-20059287

ABSTRACT

OBJECTIVES: To investigate the effectiveness of a pay-for-performance program (P4P) to increase the receipt of quality care and to decrease hospitalization rates among patients with diabetes mellitus. STUDY DESIGN: Longitudinal study of patients with diabetes enrolled in a preferred provider organization (PPO) between January 1, 1999, and December 31, 2006. METHODS: We used multivariate analyses to assess the effect of seeing P4P-participating physicians on the receipt of quality care (ie, glycosylated hemoglobin and low-density lipoprotein cholesterol testing) and on hospitalization rates, controlling for patient characteristics. RESULTS: Patients with diabetes who saw P4P-participating physicians were more likely to receive quality care than those who did not (odds ratio, 1.16; 95% confidence interval, 1.11-1.22; P <.001). Patients with diabetes who received quality care were less likely to be hospitalized than those who did not (incident rate ratio, 0.80; 95% confidence interval, 0.80-0.85; P <.001). During 1 year, there was no difference in hospitalization rates between patients with diabetes who saw P4P-participating physicians versus those who did not. However, patients with diabetes who saw P4P-participating physicians in 3 consecutive years were less likely to be hospitalized than those who did not (incident rate ratio, 0.75; 95% confidence interval, 0.61-0.93; P <.01). CONCLUSIONS: A P4P can significantly increase the receipt of quality care and decrease hospitalization rates among patients with diabetes in a PPO setting. Although it is possible that the differences observed between P4P-participating physicians and non-P4P-participating physicians were due to selection bias, we found no significant difference in the receipt of quality care between patients with diabetes who saw new P4P-participating physicians versus non-P4P-participating physicians during the baseline year. Further research should focus on defining the effect of P4Ps on intermediate outcomes such as glycosylated hemoglobin and low-density lipoprotein cholesterol levels.


Subject(s)
Diabetes Mellitus/economics , Preferred Provider Organizations/economics , Quality Assurance, Health Care/economics , Reimbursement, Incentive/economics , Aged , Diabetes Complications/diagnosis , Diabetes Complications/economics , Diabetes Complications/prevention & control , Diabetes Mellitus/therapy , Female , Hawaii , Hospitalization/economics , Hospitalization/statistics & numerical data , Hospitalization/trends , Humans , Longitudinal Studies , Male , Middle Aged , Multivariate Analysis , Physician Incentive Plans/economics , Physician Incentive Plans/trends , Practice Patterns, Physicians'/economics , Practice Patterns, Physicians'/trends , Preferred Provider Organizations/trends , Quality Assurance, Health Care/methods , Quality Assurance, Health Care/trends , Reimbursement, Incentive/trends
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