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7. The Effect of Performance-Based Financial Incentives on Improving Patient Care Experiences: A Statewide Evaluation

Author

Rodriguez, Hector P., Glahn, Ted, Elliott, Marc N., Rogers, William H., and Safran, Dana Gelb

Subjects
Medicine & Public Health, Internal Medicine, financial incentives, pay-for-performance, public reporting, patients’ experiences of care, quality improvement
Abstract

Patient experience measures are central to many pay-for-performance (P4P) programs nationally, but the effect of performance-based financial incentives on improving patient care experiences has not been assessed.The study uses Clinician & Group CAHPS data from commercially insured adult patients (n = 124,021) who had visits with 1,444 primary care physicians from 25 California medical groups between 2003 and 2006. Medical directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the patient experience improvement activities adopted by groups. Multilevel regression models were used to assess the relationship between performance change on patient care experience measures and medical group characteristics, financial incentives, and performance improvement activities.Over the course of the study period, physicians improved performance on the physician-patient communication (0.62 point annual increase, p

Published
2009

11. Can teaching agenda-setting skills to physicians improve clinical interaction quality? A controlled intervention

Author

Rodriguez, Hector P, Anastario, Michael P, Frankel, Richard M, Odigie, Esosa G, Rogers, William H, von Glahn, Ted, and Safran, Dana G

Subjects
Prevention, Clinical Research, Generic health relevance, Attitude of Health Personnel, California, Clinical Competence, Communication, Education, Medical, Continuing, Female, Health Care Surveys, Humans, Male, Middle Aged, Patient Satisfaction, Patient-Centered Care, Physician-Patient Relations, Physicians, Program Evaluation, Regression Analysis, Reimbursement, Incentive, Surveys and Questionnaires, Telecommunications, Public Health and Health Services, Curriculum and Pedagogy, Medical Informatics
Abstract

BackgroundPhysicians and medical educators have repeatedly acknowledged the inadequacy of communication skills training in the medical school curriculum and opportunities to improve these skills in practice. This study of a controlled intervention evaluates the effect of teaching practicing physicians the skill of "agenda-setting" on patients' experiences with care. The agenda-setting intervention aimed to engage clinicians in the practice of initiating patient encounters by eliciting the full set of concerns from the patient's perspective and using that information to prioritize and negotiate which clinical issues should most appropriately be dealt with and which (if any) should be deferred to a subsequent visit.MethodsTen physicians from a large physician organization in California with baseline patient survey scores below the statewide 25th percentile participated in the agenda-setting intervention. Eleven physicians matched on baseline scores, geography, specialty, and practice size were selected as controls. Changes in survey summary scores from pre- and post-intervention surveys were compared between the two groups. Multilevel regression models that accounted for the clustering of patients within physicians and controlled for respondent characteristics were used to examine the effect of the intervention on survey scale scores.ResultsThere was statistically significant improvement in intervention physicians' ability to "explain things in a way that was easy to understand" (p = 0.02) and marginally significant improvement in the overall quality of physician-patient interactions (p = 0.08) compared to control group physicians. Changes in patients' experiences with organizational access, care coordination, and office staff interactions did not differ by experimental group.ConclusionA simple and modest behavioral training for practicing physicians has potential to positively affect physician-patient relationship interaction quality. It will be important to evaluate the effect of more extensive trainings, including those that work with physicians on a broader set of communication techniques.

Published
2008

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