TY - JOUR
AU - J. Unutzer
AU - Y. F. Chan
AU - E. Hafer
AU - J. Knaster
AU - A. Shields
AU - D. Powers
AU - R. C. Veith
A1 - 
AB - Objectives. We evaluated a quality improvement program with a pay-for-performance (P4P) incentive in a population-focused, integrated care program for safety-net patients in 29 community health clinics. Methods. We used a quasi-experimental design with 1673 depressed adults before and 6304 adults after the implementation of the P4P program. Survival analyses examined the time to improvement in depression before and after implementation of the P4P program, with adjustments for patient characteristics and clustering by health care organization. Results. Program participants had high levels of depression, other psychiatric and substance abuse problems, and social adversity. After implementation of the P4P incentive program, participants were more likely to experience timely follow-up, and the time to depression improvement was significantly reduced. The hazard ratio for achieving treatment response was 1.73 (95% confidence interval = 1.39, 2.14) after the P4P program implementation compared with pre-program implementation. Conclusions. Although this quasi-experiment cannot prove that the P4P initiative directly caused improved patient outcomes, our analyses strongly suggest that when key quality indicators are tracked and a substantial portion of payment is tied to such quality indicators, the effectiveness of care for safety-net populations can be substantially improved.
BT - American Journal of Public Health
C5 - Financing & Sustainability
CP - 6
CY - United States
DO - 10.2105/AJPH.2011.300555
IS - 6
JF - American Journal of Public Health
N2 - Objectives. We evaluated a quality improvement program with a pay-for-performance (P4P) incentive in a population-focused, integrated care program for safety-net patients in 29 community health clinics. Methods. We used a quasi-experimental design with 1673 depressed adults before and 6304 adults after the implementation of the P4P program. Survival analyses examined the time to improvement in depression before and after implementation of the P4P program, with adjustments for patient characteristics and clustering by health care organization. Results. Program participants had high levels of depression, other psychiatric and substance abuse problems, and social adversity. After implementation of the P4P incentive program, participants were more likely to experience timely follow-up, and the time to depression improvement was significantly reduced. The hazard ratio for achieving treatment response was 1.73 (95% confidence interval = 1.39, 2.14) after the P4P program implementation compared with pre-program implementation. Conclusions. Although this quasi-experiment cannot prove that the P4P initiative directly caused improved patient outcomes, our analyses strongly suggest that when key quality indicators are tracked and a substantial portion of payment is tied to such quality indicators, the effectiveness of care for safety-net populations can be substantially improved.
PP - United States
PY - 2012
SN - 1541-0048; 0090-0036
EP - 5
EP - e41+
T1 - Quality Improvement With Pay-for-Performance Incentives in Integrated Behavioral Health Care
T2 - American Journal of Public Health
TI - Quality Improvement With Pay-for-Performance Incentives in Integrated Behavioral Health Care
U1 - Financing & Sustainability
U2 - 22515849
U3 - 10.2105/AJPH.2011.300555
VL - 102
VO - 1541-0048; 0090-0036
Y1 - 2012
ER -