Address correspondence to Peter J. Fagan, Ph.D., Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Johns Hopkins Healthcare LLC, 6704 Curtis Court, Glen Burnie, MD 21060; e-mail: firstname.lastname@example.org. Alyson B. Schuster, M.P.H., M.B.A., Shannon M.E. Murphy, M.A., and Linda Dunbar, R.N., Ph.D., are with the Johns Hopkins Healthcare LLC, Glen Burnie, MD. Cynthia Boyd, M.D., M.P.H., is with the Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD. Jill A. Marsteller, Ph.D., M.P.P., is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Michael Griswold, Ph.D., is with the University of Mississippi Medical Center, Jackson, MS. Christopher B. Forrest, M.D., Ph.D., is with the Children's Hospital of Philadelphia, Philadelphia, PA.
Chronic Care Improvement in Primary Care: Evaluation of an Integrated Pay-for-Performance and Practice-Based Care Coordination Program among Elderly Patients with Diabetes
Article first published online: 17 SEP 2010
© Health Research and Educational Trust
Health Services Research
Volume 45, Issue 6p1, pages 1763–1782, December 2010
How to Cite
Fagan, P. J., Schuster, A. B., Boyd, C., Marsteller, J. A., Griswold, M., Murphy, S. M. E., Dunbar, L. and Forrest, C. B. (2010), Chronic Care Improvement in Primary Care: Evaluation of an Integrated Pay-for-Performance and Practice-Based Care Coordination Program among Elderly Patients with Diabetes. Health Services Research, 45: 1763–1782. doi: 10.1111/j.1475-6773.2010.01166.x
- Issue published online: 8 NOV 2010
- Article first published online: 17 SEP 2010
- Pay for performance;
- care management;
- primary care;
- outcomes measurement;
- evaluation design;
- longitudinal study
Objective. To examine the effects of an intervention comprising (1) a practice-based care coordination program, (2) augmented by pay for performance (P4P) for meeting quality targets, and (3) complemented by a third-party disease management on quality of care and resource use for older adults with diabetes.
Data Sources/Study Setting. Claims files of a managed care organization (MCO) for 20,943 adults aged 65 and older with diabetes receiving care in Alabama, Tennessee, or Texas, from January 2004 to March 2007.
Study Design. A quasi-experimental, longitudinal study in which pre- and postdata from 1,587 patients in nine intervention primary care practices were evaluated against 19,356 patients in MCO comparison practices (>900). Five incentivized quality measures, two nonincentivized measures, and two resource-use measures were investigated. We examined trends and changes in trends from baseline to follow-up, contrasting intervention and comparison group member results.
Principal Findings. Quality of care generally improved for both groups during the study period. Only slight differences were seen between the intervention and comparison group trends and changes in trends over time.
Conclusions. This study did not generate evidence supporting a beneficial effect of an on-site care coordination intervention augmented by P4P and complemented by third-party disease management on diabetes quality or resource use.