Quality improvement with pay-for-performance incentives in integrated behavioral health care

We evaluated a quality improvement program with a pay-for-performance (P4P) incentive in a population-focused, integrated care program for safety-net patients in 29 community health clinics. We used a quasi-experimental design with 1673 depressed adults before and 6304 adults after the implementatio...

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Published in:American journal of public health (1971) 2012-06, Vol.102 (6), p.e41-e45
Main Authors: Unützer, Jürgen, Chan, Ya-Fen, Hafer, Erin, Knaster, Jessica, Shields, Anne, Powers, Diane, Veith, Richard C
Format: Article
Language:English
Subjects:
Adult
Clinical outcomes
Collaboration
Community Health Services - standards
Delivery of Health Care, Integrated - organization & administration
Depression - therapy
Drug abuse
Female
Follow-Up Studies
Health care policy
Health facilities
Health services
Humans
Incentives
Integrated approach
Integrated delivery systems
Low income groups
Male
Medical research
Mental depression
Mental disorders
Mental Disorders - therapy
Mental health
Mental health care
Middle Aged
Online Only
Patients
Physician Incentive Plans
Primary care
Primary Health Care - standards
Psychiatrists
Public health
Quality improvement
Quality of Health Care
Reimbursement, Incentive
Suicides & suicide attempts
Treatment Outcome
United States
Washington
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Shields, Anne
Powers, Diane
Veith, Richard C
description We evaluated a quality improvement program with a pay-for-performance (P4P) incentive in a population-focused, integrated care program for safety-net patients in 29 community health clinics. We used a quasi-experimental design with 1673 depressed adults before and 6304 adults after the implementation of the P4P program. Survival analyses examined the time to improvement in depression before and after implementation of the P4P program, with adjustments for patient characteristics and clustering by health care organization. Program participants had high levels of depression, other psychiatric and substance abuse problems, and social adversity. After implementation of the P4P incentive program, participants were more likely to experience timely follow-up, and the time to depression improvement was significantly reduced. The hazard ratio for achieving treatment response was 1.73 (95% confidence interval=1.39, 2.14) after the P4P program implementation compared with pre-program implementation. Although this quasi-experiment cannot prove that the P4P initiative directly caused improved patient outcomes, our analyses strongly suggest that when key quality indicators are tracked and a substantial portion of payment is tied to such quality indicators, the effectiveness of care for safety-net populations can be substantially improved.
doi_str_mv 10.2105/AJPH.2011.300555
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subjects Adult
Clinical outcomes
Collaboration
Community Health Services - standards
Delivery of Health Care, Integrated - organization & administration
Depression - therapy
Drug abuse
Female
Follow-Up Studies
Health care policy
Health facilities
Health services
Humans
Incentives
Integrated approach
Integrated delivery systems
Low income groups
Male
Medical research
Mental depression
Mental disorders
Mental Disorders - therapy
Mental health
Mental health care
Middle Aged
Online Only
Patients
Physician Incentive Plans
Primary care
Primary Health Care - standards
Psychiatrists
Public health
Quality improvement
Quality of Health Care
Reimbursement, Incentive
Suicides & suicide attempts
Treatment Outcome
United States
Washington
title Quality improvement with pay-for-performance incentives in integrated behavioral health care
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