scholarly journals Pay-for-performance schemes: Should optimal prices vary across system and clinical quality indicators?

2019 ◽  
Author(s):  
Sverre Ole Grepperud
Keyword(s):  
Quality Indicators ◽  
Pay For Performance ◽  
Optimal Price ◽  
Health Records ◽  
Clinical Indicators ◽  
Clinical Quality ◽  
Agent Interactions ◽  
Quality Costs ◽  
Internal Incentive ◽  
Different Levels

Quality indicators are classified into system or clinical quality indicators. Typically, different levels of an organization steer each of the two types of indicators. Decentralized levels control clinical indicators (blood pressure, blood sugar etc.) while centralized levels control system indicators (waiting time, electronic health records etc.). In this paper we examine optimal pay-for-performance schemes for the two indicators by considering a model consisting of hierarchy of principal-agent interactions where pay-for-performance rewards are distributed to the centralized level (unit of accountability). We find that the optimal pay-for-performance price depends on factors such as the degree and distribution of altruistic preferences, quality costs, the marginal cost of public funds, and the interdependence between the quality variables. The optimal price should differ for system and clinical indicators both when an internal incentive system is in place and when this is not the case. The optimal price for clinical indicators is to reflect the centralized levels’ ability to steer the decentralized level - the type of internal contract that exists between the two levels of the organization. The optimal price for system indicators is independent of the type of internal contract since such indicators are under the control of the unit of accountability. Finally, it is shown that rewarding organizations on the basis of clinical quality indicators can be optimal also when such incentives are not transmitted to the decentralized level of the organization. This conclusion is the result of the indirect effects that non-incentivized variables (system indicators) might have on the incentivized ones (clinical indicators).Published: Online May 2019. 

Measuring The Quality Of Cancer Care In The Barwon South Western Region, Victoria, Australia

2020 ◽  
Author(s):  
Leigh M Matheson ◽  
Graham Pitson ◽  
Cheng Hon Yap ◽  
Madhu Singh ◽  
Ian Collins ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Services ◽  
Quality Indicators ◽  
Cancer Care ◽  
Population Based ◽  
Western Region ◽  
Clinical Indicators ◽  
Clinical Quality ◽  
Quality Registry

ABSTRACT Objective The implementation of clinical quality indicators for monitoring cancer care in regional, rural and remote areas. Design Retrospective data from a population-based Clinical Quality Registry for lung, colorectal, and breast cancer. Setting All major Health Services in the Barwon South Western Region, Victoria, Australia. Participants All patients diagnosed with cancer presenting to a Health Service Intervention(s) Main Outcome Measures(s) Clinical Quality Indicators for Lung, Colorectal and Breast Cancer Results Clinical indicators included the following: discussion at multidisciplinary meetings, timeliness of care provided, type of care for different stages of the disease and survival outcomes. Many of the derived clinical indicator targets were reached. However, variation led to improvement in tumour stage being recorded in the medical record; improved awareness of the need for adjuvant chemotherapy for colorectal cancer; a reduction in time to treatment for lung cancer; reduced time to surgery for breast cancer; and highlighted the 30 day mortality post treatment for all of the tumour streams. Conclusions Clinical quality indicators allow for valuable insights into patterns of care, driving improvement in the quality of cancer care. These indicators are easily reproduced and may be of use to other cancer centres and health services.

scholarly journals Improving Clinical Quality Indicators Through Electronic Health Records: It Takes More Than Just a Reminder

PEDIATRICS ◽  
2009 ◽  
Vol 124 (1) ◽  
pp. 375-377 ◽  
Author(s):  
D. F. Sittig ◽  
J. M. Teich ◽  
J. A. Osheroff ◽  
H. Singh
Keyword(s):  
Electronic Health Records ◽  
Quality Indicators ◽  
Health Records ◽  
Clinical Quality ◽  
Electronic Health

Effect of hospital interventions to improve patient flow on emergency department clinical quality indicators

2020 ◽  
pp. emermed-2019-208579
Author(s):  
Simon Sethi ◽  
Caroline Boulind ◽  
Julie Reeve ◽  
Amanda Carney ◽  
Stevan Bruijns
Keyword(s):  
Emergency Department ◽  
Quality Indicators ◽  
Royal College ◽  
District Hospital ◽  
Design Science ◽  
Patient Flow ◽  
Pearson Correlation ◽  
Science Research ◽  
Rank Test ◽  
Clinical Quality

IntroductionThe Royal College of Emergency Medicine highlights poor flow through hospitals as a major challenge to improving emergency department flow. We describe the effect of several hospital-wide flow interventions on Yeovil District Hospital’s emergency department flow.MethodsDuring 2016, a design science research study addressed several areas disproportionally contributing to exit block within Yeovil District Hospital. In this follow-up study, we used a retrospective, before/after design, to describe the effect of these interventions on the ED. We used the Royal College of Emergency Medicine’s clinical quality indicators (4-hour standard, time to decision-maker, 7-day unplanned reattendance, left without being seen, ambulatory patient care and patient experience). Pearson correlation coefficient (r) was used to compare variables. Wilcoxon signed-rank test was used to compare performance before and after the intervention.ResultsYeovil District Hospital emergency department was attended by 160 373 patients between August 2015 and October 2018. Mean monthly attendance was 4112 (±342) patients, mean age was 43 (±28) years with equal male/female split (49/51%). The 4-hour standard made a recovery from 92% to 97% (p=0.01) that did not correlate with a recovery in national data (r=0.09); this despite rising attendances both at Yeovil and nationally (r=0.75). All clinical quality indicators improved significantly (except unplanned reattendance and patient feedback which improved but not significantly).DiscussionThe positive effect on emergency department clinical quality indicators reveals the beneficial impact of improving in-patient flow. Qualitative research is needed to better understand facilitators and barriers to flow improvement work. 

scholarly journals Optimal price-setting in pay for performance schemes in health care

2016 ◽  
Vol 123 ◽  
pp. 57-77 ◽  
Author(s):  
Søren Rud Kristensen ◽  
Luigi Siciliani ◽  
Matt Sutton
Keyword(s):  
Health Care ◽  
Pay For Performance ◽  
Price Setting ◽  
Optimal Price

A&E (ED) clinical quality indicators

2011 ◽  
Vol 28 (5) ◽  
pp. 370-370 ◽  
Author(s):  
G. Hughes
Keyword(s):  
Quality Indicators ◽  
Clinical Quality

Risk-Adjusted Clinical Quality Indicators

2000 ◽  
Vol 9 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Susan I. DesHarnais ◽  
Thane M. Forthman ◽  
Judith M. Homa-Lowry ◽  
Dwight L. Wooster
Keyword(s):  
Quality Indicators ◽  
Clinical Quality

scholarly journals Substantiation of Efficiency of Digital Technologies in the Control of Health Quality Indicators Levels

2020 ◽  
pp. 20-22
Author(s):  
Diana Vladimirovna Kolomiitseva
Keyword(s):  
Health Care ◽  
Quality Indicators ◽  
Digital Technology ◽  
Digital Technologies ◽  
Great Promise ◽  
Modern Health Care ◽  
Health Quality ◽  
Low Costs ◽  
Fitness Trackers ◽  
Different Levels

The article is devoted to substantiating the effectiveness of digital technologies in controlling the level of health quality indicators on the example of medical bracelets and fitness trackers. Digital technology has become an integral part of the modern health care system at different levels. The possibility of using such technologies to monitor the health status of almost any person has great promise, since at fairly low costs significant results are shown. Controlling the level of health quality indicators with the use of digital technologies can be used to prevent serious diseases and provide the necessary assistance to patients in time.

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