title: Quality improvement with pay-for-performance incentives in integrated behavioral health care.
abstract: OBJECTIVE
  We evaluated a quality improvement program with a pay-for-performance (P4P) incentive in a population-focused, integrated care program for safety-net patients in 29 community health clinics.
  
  
  METHODS
  We used a quasi-experimental design with 1673 depressed adults before and 6304 adults after the implementation of the P4P program. Survival analyses examined the time to improvement in depression before and after implementation of the P4P program, with adjustments for patient characteristics and clustering by health care organization.
  
  
  RESULTS
  Program participants had high levels of depression, other psychiatric and substance abuse problems, and social adversity. After implementation of the P4P incentive program, participants were more likely to experience timely follow-up, and the time to depression improvement was significantly reduced. The hazard ratio for achieving treatment response was 1.73 (95% confidence interval=1.39, 2.14) after the P4P program implementation compared with pre-program implementation.
  
  
  CONCLUSIONS
  Although this quasi-experiment cannot prove that the P4P initiative directly caused improved patient outcomes, our analyses strongly suggest that when key quality indicators are tracked and a substantial portion of payment is tied to such quality indicators, the effectiveness of care for safety-net populations can be substantially improved.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195-6560, USA. unutzer@uw.edu
authors.forename: Jürgen
authors.initials: J
authors.lastname: Unützer
authors.forename: Ya-Fen
authors.initials: YF
authors.lastname: Chan
authors.forename: Erin
authors.initials: E
authors.lastname: Hafer
authors.forename: Jessica
authors.initials: J
authors.lastname: Knaster
authors.forename: Anne
authors.initials: A
authors.lastname: Shields
authors.forename: Diane
authors.initials: D
authors.lastname: Powers
authors.forename: Richard C
authors.initials: RC
authors.lastname: Veith
mesh_terms: D000328:Adult; D003153:Community Health Services / Q000592:standards*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003863:Depression / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D010816:Physician Incentive Plans; D011320:Primary Health Care / Q000592:standards; D011787:Quality of Health Care; D012052:Reimbursement, Incentive; D016896:Treatment Outcome; D014481:United States; D014861:Washington