Has Pay‐for‐Performance Decreased Access for Minority Patients?

Ryan, Andrew M.

doi:10.1111/j.1475-6773.2009.01050.x

Cited by 37 publications

(36 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[44][45][46][47] Patient perceived pain control is a key quality indicator for hospitals. Some providers are financially incentivized to aggressively treat pain because their salaries are tied to patient satisfaction scores that encompass pain control metrics.…”

Section: Introductionmentioning

confidence: 99%

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

et al. 2015

View full text Add to dashboard Cite

BACKGROUND: Chronic opioid therapy for chronic pain treatment has increased. Hospital physicians, including hospitalists and medical/surgical resident physicians, care for many hospitalized patients, yet little is known about opioid prescribing at hospital discharge and future chronic opioid use. OBJECTIVE: We aimed to characterize opioid prescribing at hospital discharge among 'opioid naïve' patients. Opioid naïve patients had not filled an opioid prescription at an affiliated pharmacy 1 year preceding their hospital discharge. We also set out to quantify the risk of chronic opioid use and opioid refills 1 year post discharge among opioid naïve patients with and without opioid receipt at discharge. DESIGN: This was a retrospective cohort study. PARTICIPANTS: From 1 January 2011 to 31 December 2011, 6,689 opioid naïve patients were discharged from a safety-net hospital. MAIN MEASURE: Chronic opioid use 1 year post discharge. KEY RESULTS: Twenty-five percent of opioid naïve patients (n=1,688) had opioid receipt within 72 hours of discharge. Patients with opioid receipt were more likely to have diagnoses including neoplasm (6.3 % versus 3.5 %, p<0.001), acute pain (2.7 % versus 1.0 %, p<0.001), chronic pain at admission (12.1 % versus 3.3 %, p<0.001) or surgery during their hospitalization (65.1 % versus 18.4 %, p<0.001) compared to patients without opioid receipt. Patients with opioid receipt were less likely to have alcohol use disorders (15.7 % versus 20.7 %, p<0.001) and mental health disorders (23.9 % versus 31.4 %, p<0.001) compared to patients without opioid receipt. Chronic opioid use 1 year post discharge was more common among patients with opioid receipt (4.1 % versus 1.3 %, p<0.0001) compared to patients without opioid receipt. Opioid receipt was associated with increased odds of chronic opioid use (AOR=4.90, 95 % CI 3.22-7.45) and greater subsequent opioid refills (AOR=2.67, 95 % CI 2.29-3.13) 1 year post discharge compared to no opioid receipt. CONCLUSION:Opioid receipt at hospital discharge among opioid naïve patients increased future chronic opioid use. Physicians should inform patients of this risk prior to prescribing opioids at discharge.

show abstract

Section: Introductionmentioning

confidence: 99%

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Little evidence about effect of P4P was found in one study [52]. Also one systematic review found that P4P in rural areas, are likely to increase disparities in quality of care and health outcomes [53].…”

Section: Access To Carementioning

confidence: 99%

“…Diabetes outcomes [46] Quasi experimental LDL-C b100 mg/dL: +12 Access to minority patients [52] Before-after little evidence that the PHQID reduced access for minority patients -Disparities in quality [53] Literature review P4P in rural areas, are likely to increase disparities in quality of care & health outcomes.…”

Section: Referencesmentioning

confidence: 99%

Impact of Pay-for-Performance on Efficiency and Effectiveness in Hospitals: A Systematic Review

et al. 2014

View full text Add to dashboard Cite

Ab s t r a c tPurpose: Pay-for-performance (P4P) refers to the transfer of money on taking a measurable action or achieving a predetermined performance target. In this systematic review, we will present the results of P4P impacts based on published articles. Methods:A systematic review of literature was done using following databases and search engines: PubMed, Web of knowledge, Sciencedirect, The Cochrane library, MagIran and SID. Keywords used were, Pay-for-performance, P4P, output based payment, result based payment, financial incentives, value based purchasing, effectiveness, efficiency, cost, quality, patient satisfaction, provider satisfaction, mortality, length of stay, clinical outcomes, charges, access, hospitalization, equity, patient outcome, outcome of care. No limitations were considered for time of publishing studies, and searching articles was continued until February 2013. Only impact of P4P on physicians and nurses in hospitals were considered. The literature search yielded 7172 records, of which 34 met our inclusion criteria. Results:Thirty-four studies were included in this systematic review taking part in different countries and settings with different type of studies. P4P effects can be judged to be encouraging or disappointing, depending on the design choices and characteristics of the context in which it was introduced. Conclusion:The impact of P4P targeting physicians and nurses seems to be positive on most of the effectiveness and efficiency indicators. However, implementation of P4P should be accompanied by robust evaluation plans.

show abstract

“…34 Similarly, another study found no difference in access to hospitalization or to CABG for racial and ethnic minorities under the Premier program. 35 Another ongoing P4P program is more precisely a penalty-for-performance program. The Hospital Readmissions Reduction Program, which launched in October 2012, penalizes hospitals with high readmission rates for AMI, HF, and pneumonia.…”

Section: Putting Dollars In Play: Pay For Performancementioning

confidence: 99%