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Evidence-based perspectives on pay for performance and quality of patient care and outcomes in emergency medicine.
Ann Emerg Med 2008; 51(5):622-31AE

Abstract

Pay for performance is gaining momentum as a means to improve the quality of clinical care. Recently, the Centers for Medicare & Medicaid Services has expanded pay for performance initiatives to incorporate 9 emergency care metrics, including indicators for cardiac, pneumonia, and stroke care. The American College of Cardiology and American Heart Association (ACC/AHA) have published methodology for the selection and creation of performance measures for quantifying the quality of cardiovascular care. The purpose of this study is to grade each of the 9 Physician Quality Reporting Initiative emergency medicine process measures according to the ACC/AHA criteria related to clinical evidence (yes, no, indeterminate). Five of the 9 recently selected metrics in emergency medicine do not appear to meet all of the ACC/AHA criteria for measurement selection. Several of the metrics, including aspirin for acute myocardial infarction (mean hospital adherence 94.7%; SD 6.7%) and pulse oximetry for community-acquired pneumonia (mean 99.4%; SD 2.0%), already have high levels of performance nationally, which raises uncertainty about the overall cost-effectiveness of quality improvement interventions for these measures. Formal methodology needs to be established for future selection of performance measures for quality improvement programs in emergency care. These performance measures should focus on unique aspects of emergency and acute care, including recognition and treatment of time-sensitive life-threatening conditions, assessment of patients with undifferentiated signs and symptoms, and care of all-inclusive geographically based patient populations. In key emergency therapeutic areas, the evidence linking treatment and improved patient outcomes will require additional study before inclusion in pay for performance programs. New research initiatives are needed to assess the effect of timely administration of emergency department interventions on patient outcomes.

Authors+Show Affiliations

Department of Surgery, Division of Emergency Medicine, and Centers for Clinical and Genetic Economics, Duke Clinical Research Institute, Durham, NC, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

18358566

Citation

Glickman, Seth W., et al. "Evidence-based Perspectives On Pay for Performance and Quality of Patient Care and Outcomes in Emergency Medicine." Annals of Emergency Medicine, vol. 51, no. 5, 2008, pp. 622-31.
Glickman SW, Schulman KA, Peterson ED, et al. Evidence-based perspectives on pay for performance and quality of patient care and outcomes in emergency medicine. Ann Emerg Med. 2008;51(5):622-31.
Glickman, S. W., Schulman, K. A., Peterson, E. D., Hocker, M. B., & Cairns, C. B. (2008). Evidence-based perspectives on pay for performance and quality of patient care and outcomes in emergency medicine. Annals of Emergency Medicine, 51(5), pp. 622-31. doi:10.1016/j.annemergmed.2008.01.010.
Glickman SW, et al. Evidence-based Perspectives On Pay for Performance and Quality of Patient Care and Outcomes in Emergency Medicine. Ann Emerg Med. 2008;51(5):622-31. PubMed PMID: 18358566.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evidence-based perspectives on pay for performance and quality of patient care and outcomes in emergency medicine. AU - Glickman,Seth W, AU - Schulman,Kevin A, AU - Peterson,Eric D, AU - Hocker,Michael B, AU - Cairns,Charles B, Y1 - 2008/03/21/ PY - 2007/09/14/received PY - 2007/12/20/revised PY - 2008/01/07/accepted PY - 2008/3/25/pubmed PY - 2008/5/16/medline PY - 2008/3/25/entrez SP - 622 EP - 31 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 51 IS - 5 N2 - Pay for performance is gaining momentum as a means to improve the quality of clinical care. Recently, the Centers for Medicare & Medicaid Services has expanded pay for performance initiatives to incorporate 9 emergency care metrics, including indicators for cardiac, pneumonia, and stroke care. The American College of Cardiology and American Heart Association (ACC/AHA) have published methodology for the selection and creation of performance measures for quantifying the quality of cardiovascular care. The purpose of this study is to grade each of the 9 Physician Quality Reporting Initiative emergency medicine process measures according to the ACC/AHA criteria related to clinical evidence (yes, no, indeterminate). Five of the 9 recently selected metrics in emergency medicine do not appear to meet all of the ACC/AHA criteria for measurement selection. Several of the metrics, including aspirin for acute myocardial infarction (mean hospital adherence 94.7%; SD 6.7%) and pulse oximetry for community-acquired pneumonia (mean 99.4%; SD 2.0%), already have high levels of performance nationally, which raises uncertainty about the overall cost-effectiveness of quality improvement interventions for these measures. Formal methodology needs to be established for future selection of performance measures for quality improvement programs in emergency care. These performance measures should focus on unique aspects of emergency and acute care, including recognition and treatment of time-sensitive life-threatening conditions, assessment of patients with undifferentiated signs and symptoms, and care of all-inclusive geographically based patient populations. In key emergency therapeutic areas, the evidence linking treatment and improved patient outcomes will require additional study before inclusion in pay for performance programs. New research initiatives are needed to assess the effect of timely administration of emergency department interventions on patient outcomes. SN - 1097-6760 UR - https://www.unboundmedicine.com/medline/citation/18358566/Evidence_based_perspectives_on_pay_for_performance_and_quality_of_patient_care_and_outcomes_in_emergency_medicine_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-0644(08)00037-1 DB - PRIME DP - Unbound Medicine ER -