title: Pay-for-performance: considerations in application to the management of spinal disorders.
abstract: METHODS
  Descriptive review.
  
  
  OBJECTIVE
  To describe the role of pay-for-performance as a health care policy that has a significant influence on the management of spinal disorders, and to consider parameters of quality measure that are likely to optimize the efficacy of a pay-for-performance system as applied to spine care.
  
  
  BACKGROUND
  Pay-for-performance arrangements have been adopted in many areas of medicine with limited evidence for improvement in quality of care. There is an important role for a system that will improve quality of care in the management of spinal disorders. The absence of accepted evidence-based approaches to the management of spinal disorders makes the choice of parameters to measure for quality difficult.
  
  
  RESULTS
  Performance parameters to consider include a continuum of measures from process variables that focus on a discrete component of the health care experience, to outcome variables that encompass the end result of care. There are advantages and limitations to each parameter discussed.
  
  
  CONCLUSIONS
  A pay-for-performance system in the management of spinal disorders should include both process variables that measure safety and outcome variables that reflect the end result of care.
authors.affiliation: Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA 94143-0728, USA. Bervens@orthosurg.ucsf.edu
authors.forename: Sigurd
authors.initials: S
authors.lastname: Berven
authors.forename: Amanda
authors.initials: A
authors.lastname: Smith
authors.forename: Kevin
authors.initials: K
authors.lastname: Bozic
authors.forename: David S
authors.initials: DS
authors.lastname: Bradford
mesh_terms: D019468:Disease Management; D006801:Humans; D010816:Physician Incentive Plans / Q000191:economics*; D011785:Quality Assurance, Health Care / Q000191:economics; D013122:Spinal Diseases / Q000191:economics* / Q000628:therapy*