Health Equity: 03/17/08

Monday, March 17, 2008

[EQ] Call for papers on primary health care in the Americas

CALL FOR PAPERS

Special Issue on Innovations in Primary Health Care in Latin America and the Caribbean

General guidelines for submission to the journal are available at http://www.ambulatorycaremanagement.com/pt/re/jacm/authorinfo.htm

The Journal of Ambulatory Care Management is a PEER-REVIEWED journal that provides timely, applied information on the most important developments and issues in ambulatory care management. http://www.ambulatorycaremanagement.com/

Over the past few decades, there have been considerable developments in the way primary health care has been organized, financed, managed, and delivered throughout the Americas. Such innovations have ranged from programs designed to provide universal access, approaches to contracting for primary care service delivery, means of integrating primary care with other social services, human resources and information technology development, and scaling up of models of chronic disease management, to name only a few.

Authors describing original research assessing primary health care organization, financing, management, and delivery in the region of Latin America and the Caribbean are invited to submit their work. We are particularly interested in impact evaluations, demonstrations of best practices, and policy analyses, but will consider other themes. All manuscripts should be submitted in English.

SUBMISSION DATES AND DEADLINES: Authors should email a structured abstract (up to 350 words and including introduction, methods, results, conclusions) no later than June 1, 2008.

The editors will then be in contact with authors upon review of the abstract. Full manuscripts will be solicited from among those authors who have submitted abstracts. The deadline for submitting completed manuscripts is September 1, 2008.

For more information or to answer any questions, authors should feel free to contact guest editor, James Macinko or journal editor, Norbert Goldfield

James Macinko, PhD University of Pennsylvania/New York University email: james.macinko@nyu.edu

Norbert Goldfield, MD Editor, The Journal of Ambulatory Care Management email: nigoldfield@mmm.com

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[EQ] Financial incentives, healthcare providers and quality improvements

Financial incentives, healthcare providers and quality improvements

A review of the evidence

Jon Christianson, University of Minnesota

Sheila Leatherman, University of North Carolina and London School of Economics

Kim Sutherland, University of Cambridge
QQUIP and the Quality Enhancing Interventions project

QQUIP (Quest for Quality and Improved Performance) is a five-year research initiative of The Health Foundation.

Available online as PDF file [110p.] at: http://www.health.org.uk/document.rm?id=485

’…..Within healthcare there has been a longstanding interest in how the type and amount of payment to healthcare organisations and practitioners affects the type and amount of services received by consumers and, ultimately, the costs of healthcare to individuals, employers, insurers and governments.

There has been an equally longstanding interest in how the cost of health services to consumers affects the services they seek out and use, along with the implications of this for overall costs at various levels of aggregation. But there has been much less attention devoted by researchers to the impact of financial

incentives on the quality of care. The Institute of Medicine in the USA has defined quality of care as ‘the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge’(p. 21).

This study reviews the healthcare literature that examines the effect of financial incentives on the behaviour of healthcare organisations and individuals with respect to the quality of care they deliver to consumers. Its purpose is to provide guidance to policy-makers in government and decision-makers in the private sector in their efforts to improve quality of care through payment reforms. In this review and synthesis we assess the quality of the evidence relating to the relationship between financial incentives for providers and quality improvement. Specifically, we address:

1. How effective are efforts to reward providers for improving the quality of care they provide or achieving benchmark levels of quality?

2. Whether, and to what degree, financial incentives intended to restrain costs and utilization have had secondary effects on quality of care?

We also review studies where the main focus was on analysis of utilisation and costs, and find clear evidence that financial incentives can influence these two outcomes. Although this is outside the scope of our ‘quality-enhancing’ brief, we include these studies in an appendix in order to provide a sense of how the literature on the impact of financial incentives on quality has evolved over time, and because many countries have a growing interest in modifying use of health services as costs continue to escalate.

We reviewed 36 published articles that examined the impacts of financial incentives directed at improving the quality of care delivered by institutional providers and by healthcare practitioners, particularly physicians. The findings from this review can be summarised as follows:

• The findings from studies on the effect of payer initiatives that reward providers for quality improvements or the attainment of quality benchmarks are mixed. Relatively few significant impacts are reported, and it is often the case that payer programmes include quality improvement components in addition to incentive payments, making it difficult to assess the independent effect of the financial incentives.

• Very little research has been done on the impact of direct payments to hospitals to improve quality. The published research to date in this area is too limited to draw conclusions with confidence.

• Though relatively more attention has been paid to preventive services, there is limited evidence that targeted interventions employing financial incentives to improve the delivery of preventive services are effective. The few studies in this area with strong research designs find small, if any, effects of payments to providers that are intended to improve quality…..”

Contents

Executive summary

1. Financial incentives and quality improvement: background and overview

Definition and background

Structure of report

2. Financial incentives directed at improving quality

Historical context

Conceptual issues

Evidence summary

Description of findings

Literature reviews

Targeted studies of the impact of payment incentives on quality

Purchaser/payer initiatives that reward physicians and other healthcare practitioners for achieving quality goals

Purchaser/payer initiatives that reward institutions for achieving quality goals

Conclusions

3. Financial incentives and secondary impacts on quality

Historical context

Structure of this chapter

Evidence summary

Description of findings

Literature reviews

Insurance-level comparisons

Hospital-level comparisons

Physician-level comparisons

System-level comparisons

Conclusions

References

Appendix 1. Financial incentives, utilisation, and costs

Appendix 2. Information on database searches

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[EQ] The Good Indicators Guide: Understanding how to use and choose indicators

The Good Indicators Guide: Understanding how to use and choose indicators

UK NHS Institute for Innovation and Improvement, 2008

Available online as PDF file [40p.] at: http://www.apho.org.uk/resource/item.aspx?RID=44584

“…..This guide is intended to be a short, practical resource for anyone in any health system who is responsible for using indicators to monitor and improve performance, systems or outcomes.

Content:

1. Introduction

2. Indicators: some useful background

3. The anatomy of an indicator

4. Understanding variation

5. Changing hearts and minds

6. Frequently asked questions

7. Criteria for good indicators and good indicator sets

8. Ten myths about indicators

9. Glossary

10. Further reading

Appendix A: Full anatomy of an indicator

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