title: Assessment of a pay-for-performance program in primary care designed by target users.
abstract: BACKGROUND
  Evidence for pay-for-performance (P4P) has been searched for in the last decade as financial incentives increased to influence behaviour of health care professionals to improve quality of care. The effectiveness of P4P is inconclusive, though some reviews reported significant effects.
  
  
  OBJECTIVE
  To assess changes in performance after introducing a participatory P4P program.
  
  
  METHODS
  An observational study with a pre- and post-measurement. Setting and subjects. Sixty-five general practices in the south of the Netherlands. Intervention. A P4P program designed by target users containing indicators for chronic care, prevention, practice management and patient experience (general practitioner's [GP] functioning and organization of care). Quality indicators were calculated for each practice. A bonus with a maximum of 6890 Euros per 1000 patients was determined by comparing practice performance with a benchmark.
  
  
  METHODS
  Quality indicators for clinical care (process and outcome) and patient experience.
  
  
  RESULTS
  We included 60 practices. After 1 year, significant improvement was shown for the process indicators for all chronic conditions ranging from +7.9% improvement for cardiovascular risk management to +11.5% for asthma. Five outcome indicators significantly improved as well as patients' experiences with GP's functioning and organization of care. No significant improvements were seen for influenza vaccination rate and the cervical cancer screening uptake. The clinical process and outcome indicators, as well as patient experience indicators were affected by baseline measures. Smaller practices showed more improvement.
  
  
  CONCLUSIONS
  A participatory P4P program might stimulate quality improvement in clinical care and improve patient experiences with GP's functioning and the organization of care.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands. k.kirschner@iq.umcn.nl
authors.forename: Kirsten
authors.initials: K
authors.lastname: Kirschner
authors.forename: Jozé
authors.initials: J
authors.lastname: Braspenning
authors.forename: Reinier P
authors.initials: RP
authors.lastname: Akkermans
authors.forename: J E Annelies
authors.initials: JE
authors.lastname: Jacobs
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
mesh_terms: D019985:Benchmarking; D005500:Follow-Up Studies; D058006:General Practice / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D015233:Models, Statistical; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D010816:Physician Incentive Plans / Q000191:economics* / Q000458:organization & administration; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration; D015397:Program Evaluation; D058996:Quality Improvement / Q000191:economics* / Q000458:organization & administration; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive / Q000458:organization & administration*