February 2011

Background

Pay-for-performance (P4P) is the strategy de jour aimed at quality improvement. It comprises a broad array of schemes to influence clinical practice at the individual or institutional level, with the aim of improving the quality of care and, to a lesser extent, reducing costs. It is being used in the US, England, some European countries, and was recently introduced in a BC pilot project to incentivize hospitals with extra funds if they meet emergency-room discharge targets.

One of the most ambitious P4P interventions was implemented in 2004 for English family practices. Although voluntary, more than 99% of English family physicians participate in the program, which provides monetary incentives for meeting targets in management of chronic diseases. Examples of incentivized quality indicators include measurement of glycosylated hemoglobin in diabetes patients, and measures of patient satisfaction such as access to a physician appointment within 48 hours. This is the second of two e-rounds, to review studies that consider the consequences of a P4P incentive program in hospitals or physician practices.