Provider Attitudes and Performance: Responses to Pay-for-Quality Incentives

Boston University Medical Campus, Boston MA

Investigators

Linked publications & trials

Abstract

The continuing adoption of quality-based financial incentives for physicians has heightened the[unreadable] need for empirical study. Whereas such pay-for-quality (P4Q) programs are relatively new to the[unreadable] health services industry, they have long existed in other sectors of the economy. Data from the[unreadable] ?Rewarding Results? demonstration project present an opportunity for empirical evaluation of[unreadable] providers? attitudes and behavioral responses to a P4Q program. This dissertation project is a[unreadable] convenience experiment that will use survey and administrative data to analyze associations[unreadable] between primary care physicians? (PCPs?) attitudes to P4Q, and post-incentive changes in[unreadable] adherence to targeted clinical behaviors. The study shall also suggest designs for P4Q incentives[unreadable] that are attitude- and context-specific based on a multivariable model that explicitly links[unreadable] provider attitudes with changes in their adherence to financially-incentivized, evidence-based,[unreadable] and routine clinical tasks. We will link secondary data from an AHRQ-funded cross-sectional[unreadable] survey on physician attitudes towards P4Q incentives with prospective administrative data on the[unreadable] physicians? adherence to clinical guidelines. The study sample were primary care physicians[unreadable] (PCPs) participating in the ?Value of Care? collaborative P4Q initiative of the Rochester[unreadable] Independent Practice Association (RIPA) and Excellus-Blue Choice HMO. We will build on the[unreadable] physician attitudes towards P4Q scale that was developed and validated from the original[unreadable] ?Rewarding Results? physician survey. We will investigate the ability of context-specific[unreadable] provider attitudes along seven core dimensions to predict post-incentive changes in adherence to[unreadable] clinical guidelines that are targeted by financial rewards. The seven dimensions of physician P4Q[unreadable] attitudes are awareness, relevance, impact, control, cooperation, salience, and unintended[unreadable] consequences. Using a conceptual framework that is a modification of the theory of planned[unreadable] behavior (TPB), and the empirical methods of multiple discriminant analysis and structural[unreadable] equation modeling, we will determine a multivariable model of provider performance, adjusting[unreadable] for the practice setting and physician characteristics. The resulting ?Provider P4Q Attitudes and[unreadable] Performance Model? will yield new evidence, on the association between attitudes and[unreadable] behavioral response to explicit P4Q financial incentives. The findings shall be directly relevant[unreadable] to policy framers, health plan managers, hospital administrators, physician group executives,[unreadable] PCPs, patients, researchers, and other stakeholders.