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Use of provider‐level dashboards and pay‐for‐performance in venous thromboembolism prophylaxis
Author(s) -
Michtalik Henry J.,
Carolan Howard T.,
Haut Elliott R.,
Lau Brandyn D.,
Streiff Michael B.,
Finkelstein Joseph,
Pronovost Peter J.,
Durkin Nowella,
Brotman Daniel J.
Publication year - 2015
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.2303
Subject(s) - medicine , dashboard , pay for performance , psychological intervention , emergency medicine , confidence interval , incentive , payment , venous thromboembolism , guideline , database , nursing , finance , thrombosis , computer science , microeconomics , economics , pathology
BACKGROUND Despite safe and cost‐effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance and payment incentives through pay‐for‐performance programs. OBJECTIVE To sequentially examine an individualized physician dashboard and pay‐for‐performance program to improve VTE prophylaxis rates among hospitalists. DESIGN Retrospective analysis of 3144 inpatient admissions. After a baseline observation period, VTE prophylaxis compliance was compared during both interventions. SETTING A 1060‐bed tertiary care medical center. PARTICIPANTS Thirty‐eight part‐time and full‐time academic hospitalists. INTERVENTIONS A Web‐based hospitalist dashboard provided VTE prophylaxis feedback. After 6 months of feedback only, a pay‐for‐performance program was incorporated, with graduated payouts for compliance rates of 80% to 100%. MEASUREMENTS Prescription of American College of Chest Physicians' guideline‐compliant VTE prophylaxis and subsequent pay‐for‐performance payments. RESULTS Monthly VTE prophylaxis compliance rates were 86% (95% confidence interval [CI]: 85–88), 90% (95% CI: 88–93), and 94% (95% CI: 93–96) during the baseline, dashboard, and combined dashboard/pay‐for‐performance periods, respectively. Compliance significantly improved with the use of the dashboard ( P = 0.01) and addition of the pay‐for‐performance program ( P = 0.01). The highest rate of improvement occurred with the dashboard (1.58%/month; P = 0.01). Annual individual physician performance payments ranged from $53 to $1244 (mean $633; standard deviation ±$350). CONCLUSIONS Direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay‐for‐performance program. Real‐time dashboards and physician‐level incentives may assist hospitals in achieving higher safety and quality benchmarks. Journal of Hospital Medicine 2015;10:172–178. © 2014 Society of Hospital Medicine