title: Influence of a Pay-for-Performance Program on Glycemic Control in Patients Living with Diabetes by Family Physicians in a Canadian Province.
abstract: OBJECTIVE
  We evaluated the influence of the introduction of a pay-for-performance program implemented in 2010 for family physicians on the glycemic control of patients with diabetes.
  
  
  METHODS
  Administrative data for all 583 eligible family physicians and 83,580 adult patients with diabetes in New Brunswick over 10 years were used. We compared the probability of receiving at least 2 tests for glycated hemoglobin (A1C) levels and achieving glycemic control before (2005-2009) and after (2010-2014) the implementation of the program and between patients divided based on whether a physician claimed the incentive or did not.
  
  
  RESULTS
  Patients living with diabetes showed greater odds of receiving at least 2 A1C tests per year if the detection of their diabetes occurred after (vs. before) the implementation of the program (OR, 99% CI=1.23, 1.18 to 1.28), if a physician claimed the incentive (vs. not claiming it) for their care (1.92, 1.87 to 1.96) in the given year, and if they were followed by a physician who ever (vs. never) claimed the incentive (1.24, 1.15 to 1.34). In a cohort-based analysis, patients for whom an incentive was claimed (vs. not claimed) had greater odds of receiving at least 2 A1C tests per year before implementation of the incentive, and these odds increased by 56% (1.49 to 1.62) following its implementation. However, there was no difference in A1C values among the various comparison groups.
  
  
  CONCLUSIONS
  Introduction of the incentive was associated with greater odds of having a minimum of 2 A1C tests per year, which may suggest that it led physicians to provide better follow-up care for patients with diabetes. However, the incentive program has not been associated with differences in glycemic control.
authors.affiliation: Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada; Centre de formation médicale du Nouveau-Brunswick, Moncton, New Brunswick, Canada.
authors.forename: Emilie
authors.initials: E
authors.lastname: LeBlanc
authors.affiliation: Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada; Centre de formation médicale du Nouveau-Brunswick, Moncton, New Brunswick, Canada; Vitalité Health Network, Moncton, New Brunswick, Canada. Electronic address: mathieu.f.belanger@usherbrooke.ca.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Bélanger
authors.affiliation: Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada; Centre de formation médicale du Nouveau-Brunswick, Moncton, New Brunswick, Canada.
authors.forename: Véronique
authors.initials: V
authors.lastname: Thibault
authors.affiliation: Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada; Centre de formation médicale du Nouveau-Brunswick, Moncton, New Brunswick, Canada; Vitalité Health Network, Moncton, New Brunswick, Canada.
authors.forename: Lise
authors.initials: L
authors.lastname: Babin
authors.affiliation: New Brunswick Department of Health, Fredericton, New Brunswick, Canada.
authors.forename: Beverly
authors.initials: B
authors.lastname: Greene
authors.affiliation: New Brunswick Department of Health, Fredericton, New Brunswick, Canada.
authors.forename: Stuart
authors.initials: S
authors.lastname: Halpine
authors.affiliation: New Brunswick Health Council, Moncton, New Brunswick, Canada.
authors.forename: Michelina
authors.initials: M
authors.lastname: Mancuso
mesh_terms: D000368:Aged; D001786:Blood Glucose; D002170:Canada; D003920:Diabetes Mellitus / Q000175:diagnosis*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010816:Physician Incentive Plans; D010821:Physicians, Family; D012052:Reimbursement, Incentive
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: administrative data; contrôle glycémique; diabetes; diabetes registry; diabète; données administratives; family physicians; financial incentive; glycemia control; incentive; incitatif financier; mesures incitatives; médecins de famille; registre diabétique