Can Incentives to Improve Quality Reduce Disparities?

Ho, Karen; Moy, Ernest; Clancy, Carolyn M.

doi:10.1111/j.1475-6773.2009.01076.x

Cited by 12 publications

(13 citation statements)

References 5 publications

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“…While there was no formal comparison group, the magnitude of these findings suggest that P4P had a significant impact on some of the physician practices. This study supports the findings of others reporting the use of P4P as a proposed strategy that may improve quality and thus positively impact health care disparities [1-6]. …”

Section: Discussionsupporting

confidence: 91%

“…The primary goal of P4P is rewarding or improving quality of care; a secondary goal is controlling cost by reducing errors and inappropriate utilizations [2]. P4P is only one of many proposed strategies that may improve quality and thus positively impact health care disparities [3-6]. A proposed strategy for addressing health disparities is engagement [7] as defined by general awareness, reflection/empowerment, and cues to action within their own practice and their communities in general.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of a Seven Practice Pilot in a Pay-for-Performance (P4P)-Based Program in Pennsylvania

Johnson

Johnson²,

Zimmerman³

et al. 2014

J. Racial and Ethnic Health Disparities

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Objectives To examine how a targeted six-month interventions impacted Best Practice/Patient Outcomes for minority patients receiving primary care in physician practices participating in a pay-for-performance (P4P) program. Methods P4P Practices were invited to participate in a pilot intervention study designed to improve care for minority patients with hypertension, diabetes or pediatric asthma. Patient medical records were reviewed to assess how the interventions impacted (n=7 practices): Body mass index, diet and exercise, smoking, compliance with visits as recommended, blood pressure, sodium intake and weight management counseling, medication reconciliation, HbA1c testing, annual lipid profile, and anti-inflammatory medications. Results Significant improvements in various clinical quality measures were observed in all seven practices. Of the 19 specified interventions, 13 were statistically significant at α=0.05 level and 14 met the target proportion. This suggests that the best practice intervention had a significant impact on some of the health care processes in the physician practices. Conclusions The most impactful interventions were those related to face-to-face educational discussions, patient medical chart documentations rather than those pertaining to medication adherence. Improvements in measuring reporting and recording of data at post-intervention were also observed.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Outcomes of a Seven Practice Pilot in a Pay-for-Performance (P4P)-Based Program in Pennsylvania

Johnson

Johnson²,

Zimmerman³

et al. 2014

J. Racial and Ethnic Health Disparities

View full text Add to dashboard Cite

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“…For additional examples of the situations where quality improvement strategies may not reduce disparities, mailed patient reminder cards may not be effective among patient populations with limited English proficiency; while public reporting may empower patients to switch from providers with lower performance measures, if minorities have fewer providers to choose from, larger disparities may ensue. 44 …”

Section: Discussionmentioning

confidence: 99%

Potential health implications of racial and ethnic disparities in meeting MTM eligibility criteria

Wang

Qiao

Shih

et al. 2014

Research in Social and Administrative Pharmacy

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Background Previous studies have found that racial and ethnic minorities would be less likely to meet the Medicare eligibility criteria for medication therapy management (MTM) services than their non-Hispanic White counterparts. Objectives To examine whether racial and ethnic disparities in health status, health services utilization and costs, and medication utilization patterns among MTM-ineligible individuals differed from MTM-eligible individuals. Methods This study analyzed Medicare beneficiaries in 2004–2005 Medicare Current Beneficiary Survey. Various multivariate regressions were employed depending on the nature of dependent variables. Interaction terms between the dummy variables for Blacks (and Hispanics) and MTM eligibility were included to test whether disparity patterns varied between MTM-ineligible and MTM-eligible individuals. Main and sensitivity analyses were conducted for MTM eligibility thresholds for 2006 and 2010. Results Based on the main analysis for 2006 MTM eligibility criteria, the proportions for self-reported good health status for Whites and Blacks were 82.82% vs. 70.75%, respectively (difference=12.07%; P< .001), among MTM-ineligible population; and 56.98% vs. 52.14%, respectively (difference=4.84%; P= .31), among MTM-eligible population. The difference between these differences was 7.23% (P< .001). In the adjusted logistic regression, the interaction effect for Blacks and MTM eligibility had an OR of 1.57 (95% Confidence Interval, or CI=0.98–2.52) on multiplicative term and difference in odds of 2.38 (95% CI=1.54–3.22) on additive term. Analyses for disparities between Whites and Hispanics found similar disparity patterns. All analyses for 2006 and 2010 eligibility criteria generally reported similar patterns. Analyses of other measures did not find greater racial or ethnic disparities among the MTM-ineligible than MTM-eligible individuals. Conclusions Disparities in MTM eligibility may aggravate existing racial and ethnic disparities in health outcomes. However, disparities in MTM eligibility may not aggravate existing disparities in health services utilization and costs and medication utilization patterns. Future studies should examine the effects of Medicare Part D on these disparities.

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“…Although the QOF was not explicitly designed to narrow disparities, associated systematic improvement and standardization in the quality of care may be expected to lead to reductions in disparities. 7 For this reason, the UK Department of Health has stated that the QOF is likely to reduce disparities. 8 In addition, the World Health Organization commission on social determinants of health has recommended that all new policies be evaluated for their impact on health disparities.…”

Section: Pay F or Per F Or M A Nc E A Nd Dispa R I T Ies In Dia Be T mentioning

confidence: 99%

Effect of a UK Pay-for-Performance Program on Ethnic Disparities in Diabetes Outcomes: Interrupted Time Series Analysis

Alshamsan¹,

Lee²,

Majeed³

et al. 2012

The Annals of Family Medicine

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PURPOSE We wanted to examine the long-term effects of the Quality and Outcomes Framework (QOF), a major pay-for-performance program in the United Kingdom, on ethnic disparities in diabetes outcomes. METHODSWe undertook an interrupted time series analysis of electronic medical record data of diabetes patients registered with 29 family practices in South West London, United Kingdom. Main outcome measures were mean hemoglobin A 1c (HbA 1c ), total cholesterol, and blood pressure. RESULTSThe introduction of QOF was associated with initial accelerated improvements in systolic blood pressure in white and black patients, but these improvements were sustained only in black patients (annual decrease: -1.68 mm Hg; 95% CI, -2.41 to -0.95 mm Hg). Initial improvements in diastolic blood pressure in white patients (-1.01 mm Hg; 95% CI, -1.79 to -0.24 mm Hg) and in cholesterol in white (-0.13 mmol/L; 95% CI, -0.21 to -0.05 mmol/L) and black (-0.10 mmol/L; 95% CI, -0.20 to -0.01 mmol/L) patients were not sustained in the post-QOF period. There was no benefi cial impact of QOF on HbA 1c in any ethnic group. Existing disparities in risk factor control remained largely intact (for example; mean HbA 1c : white 7.5%, black 7.8%, south Asian 7.8%; P <.05) at the end of the study period.CONCLUSION A universal pay-for-performance scheme did not appear to address important disparities in chronic disease management over time. Targeted quality improvement strategies may be required to improve health care in vulnerable populations.

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Can Incentives to Improve Quality Reduce Disparities?

Cited by 12 publications

References 5 publications

Outcomes of a Seven Practice Pilot in a Pay-for-Performance (P4P)-Based Program in Pennsylvania

Outcomes of a Seven Practice Pilot in a Pay-for-Performance (P4P)-Based Program in Pennsylvania

Potential health implications of racial and ethnic disparities in meeting MTM eligibility criteria

Effect of a UK Pay-for-Performance Program on Ethnic Disparities in Diabetes Outcomes: Interrupted Time Series Analysis

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