Strategies to Support Quality-Based Purchasing: A Review of the Evidence. Technical Review No. 10

摘要

The objectives of this report were to develop a conceptual model of how incentives influence provider behavior, to summarize what is known from randomized controlled trials about the effectiveness of different quality-based purchasing (QBP) strategies, to describe ongoing research, and to perform simulations to determine whether outcomes reports are too influenced by chance events to be used in QBP. Both performance-based payment incentives (e.g., additional fee-for-service or quality bonuses) and reputational incentives (e.g., public release of performance data) were assessed. The authors found that under reasonable assumptions and applications, outcomes reports can generate meaningful information about provider performance. Results were mixed among 11 performance indicators examined in 9 randomized clinical trials, 7 showed a statistically significant response to QBP strategies while 4 did not.