Pay for Performance in Emergency Medicine
ABSTRACT One of the latest market-based solutions to the rising costs and quality gaps in health care is pay for performance. Pay for performance is the use of financial incentives to promote the delivery of designated standards of care. Pay for performance represents a dramatic change in the reimbursement of providers, from fixed rates or fees, to variable compensation based on the quality of care. This article serves as an introduction to pay for performance. I discuss the goals and structure of pay for performance plans and their limitations and potential consequences in the health care arena. A particular focus is provided on pay-for-performance initiatives affecting the emergency department either directly by contracting at the group level or indirectly through hospital reward programs. I also provide a strategy to guide constructive engagement by emergency physicians in the pay-for-performance movement.
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- "When policy makers are able to influence front line service providers, we say they have a strong compact (World Bank, 2003). Some of the ways that policy makers can influence front line providers to provide improved services is through supervision and audit with feedback (Rowe et al., 2005), regulation of providers (Dussault, 2008), contracting providers to deliver particular services (Loevinsohn and Harding, 2005), paying for performance (Sikka, 2007), and providing non – pecuniary incentives to providers (Alcܽƴ zar et al., 2006). The Constituency Development Fund (CDF) in Kenya is an annual budgetary allocation from the central government to each of the country's constituencies aimed at mainly the provision of social services such as health, water and provision of education bursaries. "
ABSTRACT: We investigate the effect of institutions on the delivery of services funded by the Constituencies Development Fund (CDF) in meeting constituents' needs in Kenya. Using household survey data collected by the Kenya Institute for Public Policy Research and Analysis (KIPPRA) in 2006 from a sample of constituencies, we construct indices of voice and client power using principal component analysis. We then estimate ordered probit models regarding the rating of the performance of CDF funded projects in meeting the constituents' needs. The estimation strategy we adopt controls for potential endogeneity of the institutional measures, potential sample selection-bias and potential unobserved heterogeneity. The results indicate that higher quality institutions are associated with better service delivery outcomes.
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ABSTRACT: MEDICATION SAFETY Overlooked Renal Dosage Adjustments A retrospective analysis of 647 patients at hospital discharge com-pared required renal dosage adjust-ments to dosage actually prescribed. This study was conducted at VieCuri Medical Centre in Venlo, Netherlands. Patient demographics and renal function data were col-lected, and dosage adjustment needs were assessed via the pharmacy-supported discharge counseling ser-vice. The incidence of inappropriate dosing based on renal function was measured at hospital discharge. Thirty-seven percent of patients evaluated during the study period (237/647) had a creatinine clear-ance less than 51 mL/min/1.73 m 2 ; dosage adjustment was warranted in 23.9% (411/1,718) of prescrip-tions. When dosage adjustment should have been performed, more than 40% of prescriptions (169/411; 41.1%) were inappropri-ate for renal function (9.8% of pre-scriptions overall; 169/1,718). Fur-thermore, 60.4% (102/169) of inappropriate prescriptions pos-sessed the potential for moderate or severe clinical consequences, as evaluated by a panel of two clinical pharmacologists and one nephrolo-gist. Study authors also noted a lack of standardized dosing guidelines for agents requiring renal dosage adjustment. The authors also sug-gested that augmenting medication systems by adding dynamic renal dosing alerts would improve moni-toring. Summary: A comparison of suggested renal dosing and actual dosing at hospital discharge revealed that appropriate prescribing may be overlooked. van Dijk EA, Drabbe NRG, Kruijtbosch M, De Smet PAGM. Drug dosage adjust-ments according to renal function at hos-pital discharge. Ann Pharmacother. 2006;40:1254-1260.Hospital pharmacy 12/1122; 41(7). DOI:10.1310/hpj4311-937
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ABSTRACT: To get an idea of whether the issue of what makes people healthier is studied in ophthalmology by determining the proportion of articles dealing with that subject. Prospective review of all articles published in 3 consecutive issues of 7 peer-reviewed ophthalmology journals, using a grading system in which A signified an article that clearly dealt with a subject expected to have an impact on health or quality of life, or that considered health or quality of life itself directly; B indicated an article similar to A, but not directly concerned with the issue of health; C signified an article similar to B but more distantly related to health or quality of life; and D was the grade given when there was no relationship at all to health or quality of life. Grading was done independently by 3 graders. A literature review on the subject was also performed. Thirty-three articles received a grade of A, 229 of B, 740 of C, and 81 of D. There were more articles that had no relationship at all to health or quality of life than there were articles dealing directly with those issues. On the basis of a review of the literature and of over 1000 articles, ophthalmologists do not appear to give much priority to issues of quality of life or health. How validly these conclusions can be generalized to general clinicians is not known.Transactions of the American Ophthalmological Society 02/2007; 105:214-23; discussion 223-4.