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 .
Frequency and characteristics of cognitive services provided in response to a financial incentive.
OBJECTIVE To determine the effects of a financial incentive on the number and types of  cognitive services ( CS )  provided by community pharmacies to Medicaid recipients in the State of Washington . DESIGN Prospect i ve r and omized trial . CS were reported using a problem-intervention- result coding system over a 20-month period . SETTING AND SUBJECTS Pharmacists practicing in 110 study ( financial incentive ) and 90 control community pharmacies . RESULTS Study pharmacists documented an average of 1.59 CS interventions per 100 prescriptions over a 20-month period , significantly more than controls , who documented an average of 0.67 interventions ( P < .05 ) per 100 prescriptions . One-half ( 48.4 % ) of all CS were for patient-related problems , 32.6 % were for drug-related problems , 17.6 % were for prescription-related problems , and 1.4 % were for other problems that did not involve drug therapy . A change in drug therapy occurred as a result of 28 % of all CS documented in this demonstration . Changes were rarely ( 2.4 % ) due to generic or therapeutic substitution and almost always ( 90 % ) followed communication with the prescriber . The average self-reported time to perform CS was 7.5 minutes ; 75 % of interventions were < or = 6 minutes . Considerable differences existed between study and control groups in the types of problems identified , intervention activities performed , and results of interventions . CONCLUSION A financial incentive was associated with significantly more , and different types of , CS performed by pharmacists
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 .