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Table 1 Elements of the P4P program, design options and choices

From: Design choices made by target users for a pay-for-performance program in primary care: an action research approach

Component

Elements

Design options

Design choices P4P program

Performance measurement

Performance indicators

  
 

Domains, subjects and indicators

Selection of:- Clinical care (diabetes, asthma, COPD, cardiovascular risk management, influenza vaccination, cervical cancer screening, prescribing acid suppressive drugs and antibiotics)- Practice management (infrastructure, team, information, quality and safety)- Patient experience (experience with general practitioner and organisation of care)

Selected indicators for:- Clinical care: diabetes (n = 9), asthma (n = 4), COPD (n = 5), cardiovascular risk management (n = 9), influenza vaccination (n = 2), cervical cancer screening (n = 1), prescribing antibiotics (n = 2)- Practice management: infrastructure (n = 7), team (n = 8), information (n = 3), quality and safety (n = 4)- Patient experience: experience with general practitioner (n = 16) and organisation of care (n = 11)

 

Period of data collection

Data collection for all three domains each year vs. a trimmed-down version of the program

At baseline measurement of clinical care, practice management, patient experience; In following years only clinical care and patient experience

Appraisal

Unit of assessment

Individual GP vs. general practice vs. larger organisational unit

General practice

 

Performance standards

• Absolute vs. relative standards

• Same standards vs. different standards for indicators/subjects

• A relative standard set at the 25th percentile of group performance

• Different standards for indicators

 

Analysis and interpretation of performance data

  
 

Weighing the domains

Different weights vs. same weight

Clinical care : practice management : patient experience 2:1:1

 

Weighing the indicators

Different weights vs. same weight

Same weight for all indicators

 

Calculations

• Separate scores for each domain vs. one overall domain-score

• Calculations for quality level and/or improvement of performance

• Separate scores for each domain

• Calculations for both quality level and improvement of performance

 

Weighing the quality scores

Different weights vs. same weight for quality level and improvement of performance

Quality level : improvement of performance 3:1

 

Differentiation of quality scores

4 levels vs. 5-7 levels vs. 8-10 levels

7 levels

 

Feedback

• Benchmark: median vs. best practice (75th or 90th percentile) vs. a combination

• Risk adjustment: indirect vs. direct correction

• One-step procedure vs. two-step procedure

• 25th percentile, median, 75th percentile

• No risk adjustment

• Two-step procedure

Reimbursement

Financial rewards

  
 

Payment

Money vs. human resources vs. sabbatical leave vs. a combination

Money

 

Size of the bonus

5000 Euros to 10000 Euros (5-10% practice income) on average per practice (depending on practice size) → appropriate or not?

5000 Euros to 10000 Euros on average per practice (depending on practice size)Baseline: A maximum of euro 6.89 on average per patient*Following years: A maximum of euro 2.88 on average per patient*

 

Spending the bonus

No obligations vs. obligations (spending for practice with or without pre-set goal) vs. a combination

No obligations

  1. * A patient whose health insurance company was a sponsor of the P4P program