The intervention sites admitted statistically significantly more severely ill patients  than nursing homes in the control group .
Despite the
In the report Crossing the Quality Chasm ( 1 ) , the Institute of Medicine called attention to the poor quality of health care in the United States .
The Institute identified numerous factors contributing to poor quality , including the structure of the present health care payment system .
The Institute found that , for certain clinical situations , health care payment arrangements may actually produce disincentives for quality .
The largely untapped potential of the health care payment system to change physician and health care system behavior has stimulated interest in both the scientific literature ( 2 , 3 ) and the popular press ( 4 - 6 ) for linking payments to performance on quality measures .
Several health plans ( 3 , 7 ) and the Centers for Medicare & Medicaid Services are using explicit financial incentives for quality ( 8 , 9 ) .
For example , what types of clinical conditions or health care services should be the target of financial incentives to improve quality : chronic diseases , acute care , or preventive care services ?
How effective ( and cost-effective ) are financial incentives for quality ?
What are the optimum magnitude , frequency , and duration of financial incentives for quality ?
What is the optimum package of nonfinancial interventions ( if any ) to include with financial incentives for quality , for example , audit and feedback , recognition , clinical reminders , academic detailing , or information technology support ( 12 , 13 ) ?
Can we expect the effect of financial incentives to persist after they are stopped ?
Because any effective intervention will have some unanticipated effects , will important patient care activities that are not rewarded financially be neglected ?
The purpose of this paper is to assess the relationship between explicit financial incentives and the provision of high- quality health care by systematic ally review ing empirical studies .
Because the evidence regarding the relationship between the financial incentives embedded in fee-for-service and capitation arrangements and the quality of health care has been thoroughly review ed in previous work ( 14 ) , we focused our review on literature that addresses explicit financial rewards for improving health care quality .
Methods Study Identification and Selection We conducted a systematic search of the English- language literature in PubMed to find articles published between 1 January 1980 and 14 November 2005 whose main objective was to assess the use of explicit financial incentives to improve health care quality .
Access to care is the patient 's attainment of timely and appropriate health care .
Structure of care is a feature of a health care organization or clinician relevant to the provision of health care .
Process of care is a health care service provided to or on behalf of a patient .
Outcome of care is a health state of a patient result ing from health care .
Concurrent comparison groups are important because some studies of quality may show dramatic improvement over time but no statistically significant differences between intervention and comparison groups .
Enhancing mammography referral in primary care.
BACKGROUND This 1-year r and omized trial tested the efficacy of behavioral techniques for increasing mammography referrals by primary care physicians in small , community practice s. METHODS Sixty-one practice s were r and omly assigned to one of three conditions : ( 1 ) education-only control , ( 2 ) education plus cue enhancement using mammography chart stickers , and ( 3 ) education plus cue enhancement plus feedback and token rewards . Quarterly chart audits of a defined sample ( N = 11,716 ) of women patients 50 years of age or older were conducted to document mammography referrals , completions , and compliance . RESULTS Referral and completion rates increased from baseline to first quarter and gradually declined thereafter . Overall , these rates were higher in the cuing conditions than in the control condition . In contrast , compliance rates in both experimental conditions increased over the year while remaining static in the control condition , demonstrating a strong and continuing effect for cue enhancement . Compliance increases were greatest for physicians who were older , nonwhite , with a second speciality , in solo practice , not members of the AMA , not residency trained , and not board certified . CONCLUSIONS Chart stickers can significantly increase mammography utilization in small , community practice s. These practice s are an efficient route to reaching large numbers of older women in need of mammography screening
The intervention sites admitted statistically significantly more severely ill patients  than nursing homes in the control group .
Despite the
In the report Crossing the Quality Chasm ( 1 ) , the Institute of Medicine called attention to the poor quality of health care in the United States .
The Institute identified numerous factors contributing to poor quality , including the structure of the present health care payment system .
The Institute found that , for certain clinical situations , health care payment arrangements may actually produce disincentives for quality .
The largely untapped potential of the health care payment system to change physician and health care system behavior has stimulated interest in both the scientific literature ( 2 , 3 ) and the popular press ( 4 - 6 ) for linking payments to performance on quality measures .
Several health plans ( 3 , 7 ) and the Centers for Medicare & Medicaid Services are using explicit financial incentives for quality ( 8 , 9 ) .
For example , what types of clinical conditions or health care services should be the target of financial incentives to improve quality : chronic diseases , acute care , or preventive care services ?
How effective ( and cost-effective ) are financial incentives for quality ?
What are the optimum magnitude , frequency , and duration of financial incentives for quality ?
What is the optimum package of nonfinancial interventions ( if any ) to include with financial incentives for quality , for example , audit and feedback , recognition , clinical reminders , academic detailing , or information technology support ( 12 , 13 ) ?
Can we expect the effect of financial incentives to persist after they are stopped ?
Because any effective intervention will have some unanticipated effects , will important patient care activities that are not rewarded financially be neglected ?
The purpose of this paper is to assess the relationship between explicit financial incentives and the provision of high- quality health care by systematic ally review ing empirical studies .
Because the evidence regarding the relationship between the financial incentives embedded in fee-for-service and capitation arrangements and the quality of health care has been thoroughly review ed in previous work ( 14 ) , we focused our review on literature that addresses explicit financial rewards for improving health care quality .
Methods Study Identification and Selection We conducted a systematic search of the English- language literature in PubMed to find articles published between 1 January 1980 and 14 November 2005 whose main objective was to assess the use of explicit financial incentives to improve health care quality .
Access to care is the patient 's attainment of timely and appropriate health care .
Structure of care is a feature of a health care organization or clinician relevant to the provision of health care .
Process of care is a health care service provided to or on behalf of a patient .
Outcome of care is a health state of a patient result ing from health care .
Concurrent comparison groups are important because some studies of quality may show dramatic improvement over time but no statistically significant differences between intervention and comparison groups .