title: Improving the quality of primary care by allocating performance-based targets, in a diverse insured population.
abstract: Primary Care Health organizations, operating under universal coverage and a regulated package of benefits, compete mainly over quality of care. Monitoring, primary care clinical performance, has been repeatedly proven effective in improving the quality of care. In 2004, Maccabi Healthcare Services (MHS), the second largest Israeli HMO, launched its Performance Measurement System (PMS) based on clinical quality indicators. A unique module was built in the PMS to adjust for case mix while tailoring targets to the local units. This article presents the concept and formulas developed to adjust targets to the units' current performance, and analyze change in clinical indicators over a six year period, between sub-population groups.
  
  
  
  Six process and intermediate outcome indicators, representing screening for breast and colorectal cancer and care for patients with diabetes and cardiovascular disease, were selected and analyzed for change over time (2003-2009) in overall performance, as well as the difference between the lowest and the highest socio-economic ranks (SERs) and Arab and non-Arab members.
  
  
  
  MHS demonstrated a significant improvement in the selected indicators over the years. Performance of members from low SERs and Arabs improved to a greater extent, as compared to members from high ranks and non-Arabs, respectively.
  
  
  
  The performance measurement system, with its module for tailoring of units' targets, served as a managerial vehicle for bridging existing gaps by allocating more resources to lower performing units. This concept was proven effective in improving performance while reducing disparities between diverse population groups.
authors.affiliation: Department Health Systems Management, Faculty Health Sciences, Ben Gurion University of the Negev, Beer Sheva, 65321, Israel. ronitpeled@yahoo.com.|Peres Academy Center, Rehovot, Israel. ronitpeled@yahoo.com.
authors.forename: Ronit
authors.initials: R
authors.lastname: Peled
authors.affiliation: Department of Epidemiology, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.|The Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel.
authors.forename: Avi
authors.initials: A
authors.lastname: Porath
authors.affiliation: The Gertner Institute for Epidemiology and Health Policy Research, Tel Aviv, Israel.|The School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Rachel
authors.initials: R
authors.lastname: Wilf-Miron
mesh_terms: D000368:Aged; D018912:Arabs; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012923:Social Class; D019472:Universal Health Insurance
keywords: Public health; Quality improvement; Quality indicators; Quality measurement