title: Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis.
abstract: BACKGROUND
  Despite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance and payment incentives through pay-for-performance programs.
  
  
  OBJECTIVE
  To sequentially examine an individualized physician dashboard and pay-for-performance program to improve VTE prophylaxis rates among hospitalists.
  
  
  METHODS
  Retrospective analysis of 3144 inpatient admissions. After a baseline observation period, VTE prophylaxis compliance was compared during both interventions.
  
  
  METHODS
  A 1060-bed tertiary care medical center.
  
  
  METHODS
  Thirty-eight part-time and full-time academic hospitalists.
  
  
  METHODS
  A Web-based hospitalist dashboard provided VTE prophylaxis feedback. After 6 months of feedback only, a pay-for-performance program was incorporated, with graduated payouts for compliance rates of 80% to 100%.
  
  
  METHODS
  Prescription of American College of Chest Physicians' guideline-compliant VTE prophylaxis and subsequent pay-for-performance payments.
  
  
  RESULTS
  Monthly VTE prophylaxis compliance rates were 86% (95% confidence interval [CI]: 85-88), 90% (95% CI: 88-93), and 94% (95% CI: 93-96) during the baseline, dashboard, and combined dashboard/pay-for-performance periods, respectively. Compliance significantly improved with the use of the dashboard (P = 0.01) and addition of the pay-for-performance program (P = 0.01). The highest rate of improvement occurred with the dashboard (1.58%/month; P = 0.01). Annual individual physician performance payments ranged from $53 to $1244 (mean $633; standard deviation ±$350).
  
  
  CONCLUSIONS
  Direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program. Real-time dashboards and physician-level incentives may assist hospitals in achieving higher safety and quality benchmarks.
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland; Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland.
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Michtalik
authors.forename: Howard T
authors.initials: HT
authors.lastname: Carolan
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: Brandyn D
authors.initials: BD
authors.lastname: Lau
authors.forename: Michael B
authors.initials: MB
authors.lastname: Streiff
authors.forename: Joseph
authors.initials: J
authors.lastname: Finkelstein
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Nowella
authors.initials: N
authors.lastname: Durkin
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Brotman
mesh_terms: D019985:Benchmarking / Q000592:standards* / Q000706:statistics & numerical data; D002983:Clinical Competence / Q000592:standards*; D020445:Hospitalists / Q000592:standards*; D006801:Humans; D056990:Post-Exposure Prophylaxis / Q000592:standards* / Q000706:statistics & numerical data; D012052:Reimbursement, Incentive / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*