The effect of a PPO pay-for-performance program on patients with diabetes.
OBJECTIVE
To investigate the effectiveness of a pay-for-performance program (P4P) to increase the receipt of quality care and to decrease hospitalization rates among patients with diabetes mellitus.


METHODS
Longitudinal study of patients with diabetes enrolled in a preferred provider organization (PPO) between January 1, 1999, and December 31, 2006.


METHODS
We used multivariate analyses to assess the effect of seeing P4P-participating physicians on the receipt of quality care (ie, glycosylated hemoglobin and low-density lipoprotein cholesterol testing) and on hospitalization rates, controlling for patient characteristics.


RESULTS
Patients with diabetes who saw P4P-participating physicians were more likely to receive quality care than those who did not (odds ratio, 1.16; 95% confidence interval, 1.11-1.22; P <.001). Patients with diabetes who received quality care were less likely to be hospitalized than those who did not (incident rate ratio, 0.80; 95% confidence interval, 0.80-0.85; P <.001). During 1 year, there was no difference in hospitalization rates between patients with diabetes who saw P4P-participating physicians versus those who did not. However, patients with diabetes who saw P4P-participating physicians in 3 consecutive years were less likely to be hospitalized than those who did not (incident rate ratio, 0.75; 95% confidence interval, 0.61-0.93; P <.01).


CONCLUSIONS
A P4P can significantly increase the receipt of quality care and decrease hospitalization rates among patients with diabetes in a PPO setting. Although it is possible that the differences observed between P4P-participating physicians and non-P4P-participating physicians were due to selection bias, we found no significant difference in the receipt of quality care between patients with diabetes who saw new P4P-participating physicians versus non-P4P-participating physicians during the baseline year. Further research should focus on defining the effect of P4Ps on intermediate outcomes such as glycosylated hemoglobin and low-density lipoprotein cholesterol levels.
Chen
Judy Y
JY
Health Benchmarks, Inc, IMS Health, 21650 Oxnard St, Ste 550, Woodland Hills, CA 91367, USA. judy.chen@us.imshealth.com
Tian
Haijun
H
Taira Juarez
Deborah
D
Hodges
Krista A
KA
Brand
Jennifer C
JC
Chung
Richard S
RS
Legorreta
Antonio P
AP
D000368:Aged; D048909:Diabetes Complications / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000191:economics* / Q000628:therapy; D005260:Female; D006254:Hawaii; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010816:Physician Incentive Plans / Q000191:economics / Q000639:trends; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends; D011243:Preferred Provider Organizations / Q000191:economics* / Q000639:trends; D011785:Quality Assurance, Health Care / Q000191:economics* / Q000379:methods / Q000639:trends; D012052:Reimbursement, Incentive / Q000191:economics* / Q000639:trends