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 .
The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines.
BACKGROUND This study tested the effects of two organizational support processes , the provision of financial incentives for superior clinical performance and the availability of a  patient ( smoker ) registry and proactive telephone support system for smoking cessation , on provider adherence to accepted practice guidelines and associated patient outcomes . METHODS Forty clinics of a large multispecialty medical group practice providing primary care services were r and omly allocated to study conditions . Fifteen clinics each were assigned to the experimental conditions " control " ( distribution of printed versions of smoking cessation guidelines ) and " incentive " ( financial incentive pay-out for reaching preset clinical performance targets ) .  Ten clinics were r and omized to receive financial incentives combined with access to a central ized patient registry and intervention system ( " registry " ) . Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients ' smoking cessation behaviors . RESULTS  Patients ' tobacco use status  was statistically significant ( P < 0.01 ) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition . Patients visiting registry clinics accessed counseling programs statistically significantly more often ( P < 0.001 ) than patients receiving care in the control condition . Other endpoints did not statistically significantly differ between the experimental conditions . CONCLUSIONS The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practice s and patient behaviors was mixed . Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment
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 .