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A longitudinal study in a primary care organization Tino Martí, Antoni Peris and Alba Brugues

Effectiveness of a multiprofessional P4P system in clinical outcomes and organizational alignment. A longitudinal study in a primary care organization Tino Martí, Antoni Peris and Alba Brugues . Context. Worldwide implemented. USA to Europe. P4P. Process to Outcome.

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A longitudinal study in a primary care organization Tino Martí, Antoni Peris and Alba Brugues

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  1. Effectiveness of a multiprofessional P4P system in clinical outcomes and organizational alignment A longitudinal study in a primary care organization Tino Martí, Antoni Peris and Alba Brugues

  2. Context

  3. Worldwideimplemented USA toEurope P4P ProcesstoOutcome Qualityimprovement Primarycare Inconclusiveevidence

  4. $ Professionals Organization Contract Fixsalary Nightshifts Careerscalator 12%-8% P4P

  5. $ Professionals Organization Contract P4P scheme TeamClinical (40%), Individual Clinical (30%) and Excellence (30%) goals Alignedwithsystemgoals

  6. Goals

  7. Toassesstheeffectiveness of P4P schemeonqualityimprovement • Toanalysethe post-goaleffect (inertiaeffect) orwhathappens once a goalisretrieved. Goals

  8. Methods

  9. Methods Time span: • P4P scheme has beenapplied in CASAP since 2006. • Wehaveselectedthelast 4 years (2008-2011) for a betterconsistency of qualityindicators. • Thus, 2008 isthe basal yeartomeasureimprovement. 2008 2009 2010 2011

  10. Methods Healthprofessionals: • Althoughallprimarycareprofessionals are involved in the P4P scheme, wehaveselectedfamilydoctors and adult-care nurses forthisstudy. • Data availability (permanence in thecompany) duringthestudyperiod (2008-2011) has been a necessaryconditiontoallowconsistentcomparisons. • Therefore, a group of 11 familydoctors and 11 nurses wereselected. 11 11

  11. Methods Qualityindicators: • EQA is a standard set of qualityindicatorsusedacrossCataloniatoassessquality performance in PrimaryCareTeams. • EQA coversmajorchronicdiseasessuch as DM, heartfailure, COPD and cancer. • Italsoincludespreventionactivitiessuch as bloodpressure control, smokingcessation, fluvaccination. • A total of 25 qualityindicatorsweremonitoredduringthestudyperiod.

  12. Methods • Preventiveactivities • Primary • Secondary • Quaternary

  13. Results

  14. Results Improvement 08-11: 25.3% Yearlyaverage: 5,8% 22 3

  15. Results Doctors Nurses Percentagerepresentsgoal’sweight in the P4P set.

  16. Results

  17. Results

  18. Results Behaviour of Goal and Non-goalyears forgoalindicators Doctors p < 0.001 Nurses p > 0.05

  19. Results GOAL 11.9% POST -0.5% PRE 3.1% Doctors

  20. Results POST 4.8% GOAL 14.6% PRE 3.7% Nurses

  21. Results POST GOAL MORE INERTIA MORE SENSITIVENESS PRE Doctors Nurses

  22. Results Are weightsworth?

  23. Conclusions • P4P works for quality improvement at a 12-14% improvement rate • Nurses are more sensitive to incentives than doctors. • After-incentive effect is neutral for doctors and positive for nurses. • Doctors are sensitive to weights

  24. Thankyou

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