Patient assessment of diabetes care in a pay-for-performance program.

OBJECTIVE: Few studies address quality of care in pay-for-performance (P4P) programs from the perspective of patients' perceptions. This study aimed to examine and compare the patient assessment of diabetes chronic care as perceived by diabetic patients enrolled and not enrolled in a P4P program from the patients' self-reported perspectives. DESIGN: A cross-sectional study with case and comparison group design. SETTING: A large-scale survey was conducted from February to November 2013 in 18 healthcare institutions in Taiwan. PARTICIPANTS: A total of 1458 P4P (n = 1037) and non-P4P (n = 421) diabetic patients participated in this large survey. The Chinese version of the Patient Assessment of Chronic Illness Care (PACIC) instrument was used and patients' clinical outcome data (e.g. HbA1c, LDL) were collected. INTERVENTION: None. MAIN OUTCOME MEASURES: Five subscales from the PACIC were measured, including patient activation, delivery system design/system support, goal setting/tailoring, problem solving/contextual and follow-up/coordination. Patient clinical outcomes were also measured. Multiple linear regression and logistic regression models were used and controlled for patient demographic and health institution characteristics statistically. RESULTS: After adjusting for covariates, P4P patients had higher overall scores on the PACIC and five subscales than non-P4P patients. P4P patients also had better clinical processes of care (e.g. HbA1c test) and intermediate outcomes. CONCLUSIONS: Patients who participated in the program likely received better patient-centered care given the original Chronic Care Model. Better perceptions of diabetic care assessment also better clinical outcomes. The PACIC instrument can be used for the patient assessment of chronic care in a P4P program.

Catholic hospital services for vulnerable populations: are system values sufficient determinants?

BACKGROUND: Catholic hospitals and health systems comprise a substantial segment of nonprofit, mission-driven, health care services, with accountability to institutional pressures of the Roman Catholic Church as well as economic pressures for solvency. Values are the way in which the organization expresses its faith-based institutional identity, which may used to select services that represent those values. PURPOSE: The purpose of this study was to identify whether Catholic health systems' explicit values of justice or compassion (and derivatives of those words, known to have similar meaning) were associated with a greater number of system member hospitals' services aimed at vulnerable populations. METHODOLOGY: Using information from Web sites of 41 Catholic health systems in 2007 and data describing their 452 hospitals from the American Hospital Association Annual Survey, the relationship of health system values with hospital services for vulnerable populations was examined while controlling for organizational, market, and demand variables. FINDINGS: Although Catholic hospitals as a whole are more likely to provide services to vulnerable populations than to other ownership types, the results show that among Catholic hospitals, values of justice or compassion are not associated with more services (defined in this study) that reflect those values. System hospitals likely to have more services that represent the values of justice and compassion are larger, have a higher Medicaid payer mix, are located in less dense urban areas, and are members of geographically dispersed systems. PRACTICE IMPLICATIONS: Hospitals select services that may represent symbolic system values, but community need and financial means are stronger determinants. To bolster community benefit to justify tax exempt status, Catholic hospitals and systems may benefit from further defining, analyzing, and reporting the impact of access to relatively unprofitable services for previously underserved vulnerable populations.