title: Patient outcomes and evidence-based medicine in a preferred provider organization setting: a six-year evaluation of a physician pay-for-performance program.
abstract: OBJECTIVE
  To determine whether health plan members who saw physicians participating in a quality-based incentive program in a preferred provider organization (PPO) setting received recommended care over time compared with patients who saw physicians who did not participate in the incentive program, as per 11 evidence-based quality indicators.
  
  
  METHODS
  Administrative claims data for PPO members of a large nonprofit health plan in Hawaii collected over a 6-year period after the program was first implemented.
  
  
  METHODS
  An observational study allowing for multiple member records within and across years. Levels of recommended care received by members who visited physicians who did or did not participate in a quality incentive program were compared, after controlling for other member characteristics and the member's total number of annual office visits.
  
  
  METHODS
  Data for all PPO enrollees eligible for at least one of the 11 quality indicators in at least 1 year were collected.
  
  
  RESULTS
  We found a consistent, positive association between having seen only program-participating providers and receiving recommended care for all 6 years with odds ratios ranging from 1.06 to 1.27 (95 percent confidence interval: 1.03-1.08, 1.09-1.40).
  
  
  CONCLUSIONS
  Physician reimbursement models built upon evidence-based quality of care metrics may positively affect whether or not a patient receives high quality, recommended care.
authors.affiliation: Health Benchmarks Inc., Woodland Hills, CA, USA.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Gilmore
authors.forename: Yingxu
authors.initials: Y
authors.lastname: Zhao
authors.forename: Ning
authors.initials: N
authors.lastname: Kang
authors.forename: Kira L
authors.initials: KL
authors.lastname: Ryskina
authors.forename: Antonio P
authors.initials: AP
authors.lastname: Legorreta
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Taira
authors.forename: Richard S
authors.initials: RS
authors.lastname: Chung
mesh_terms: D054598:Blue Cross Blue Shield Insurance Plans; D019317:Evidence-Based Medicine; D005260:Female; D006254:Hawaii; D006302:Health Services Research; D006801:Humans; D008297:Male; D019982:Organizational Case Studies; D017063:Outcome Assessment, Health Care; D010816:Physician Incentive Plans / Q000191:economics; D011243:Preferred Provider Organizations / Q000191:economics / Q000592:standards*; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive; D013997:Time Factors