Pay for Quality
Pay for Quality
Pay for Quality
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82 <strong>Pay</strong> <strong>for</strong> <strong>Quality</strong> KCE Reports 118<br />
Figure 8: P4Q context: Provider characteristics<br />
Provider characteristics<br />
Awareness, perception, familiarity, agreement, self-efficacy:<br />
High importance of provider awareness (S)<br />
Lack of reporting on the other experience dimensions, except some evidence on the importance of involvement<br />
(W)<br />
Other motivational drivers (intrinsic, professional culture, altruism…):<br />
Lack of reporting (N)<br />
Medical leadership, role of peers, role of industry:<br />
Lack of reporting (N)<br />
Existence and implementation of clinical guidelines:<br />
Lack of reporting, although this seems one of the mediators of the general quality improvement trend co<br />
existing with the introduction of P4Q (see UK example) (N)<br />
Level of own control on changes:<br />
Lack of reporting (N), but in almost all studies (except smoking cessation studies) controllable measures were<br />
targeted. In addition most studies use intermediate instead of long term outcome targets.<br />
Target unit (individual, group/organisation, hospital, nursing home, department):<br />
Evidence of positive effects on the individual and/or team level (S).<br />
Conflicting evidence on the level of an organization (medical group, hospital) and on the level of leadership (C).<br />
In case of not-individual, size of unit (# providers):<br />
Conflicting evidence on solo vs. group practice per<strong>for</strong>mance (C)<br />
Positive relationship with the number of providers within a practice (W)<br />
No relationship with hospital size (W)<br />
Role of the meso level (principal or agent):<br />
Lack of reporting (N)<br />
Demographics (age, gender, specialty…):<br />
Significant effect of provider age, gender, training background, geographical location, and having a second<br />
specialty (W)<br />
No significant effect of provider experience and rural vs. urban location (W)<br />
Organisational resources available:<br />
Weak evidence on the influence on P4Q effects, as measured through hospital/medical group/IPA status, age<br />
of the group or organization, organization vs. individual ownership, and teaching status of an organization (W)<br />
Organisational system change and extra cost/time required:<br />
Lack of reporting (N)<br />
Number of patients and services per patient:<br />
Conflicting evidence (C)<br />
Room <strong>for</strong> improvement:<br />
Strong evidence on the influence on P4Q effects (S)