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A Multimodal Strategy Based on Pay-Per-Performance to Improve Quality of Care of Family Practitioners in Argentina

Rubinstein, Adolfo MD, MSc, PhD; Rubinstein, Fernando MPH, MD; Botargues, Marcela MD; Barani, Mariela MD; Kopitowski, Karin MD

Journal of Ambulatory Care Management: April-June 2009 - Volume 32 - Issue 2 - p 103–114
doi: 10.1097/JAC.0b013e31819940f7
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Pay-for-performance has become increasingly common to complement physician reimbursement. We designed a quality framework to measure family physicians' performance in a managed care setting in Buenos Aires. We aimed to assess the effectiveness of a multimodal intervention based on pay-for-performance, teamwork, continuous education, and audit and feedback to improve quality. After 2 years, a significant improvement was observed in most of the indicators measuring clinical effectiveness and some improvements were observed in other domains. Despite these results, a better performance matrix is needed to capture not only specific conditions but also other aspects like integrating, prioritizing, and personalizing care.

Division of Family and Community Medicine, Hospital Italiano de Buenos Aires (Drs Adolfo Rubinstein, Fernando Rubinstein, Botargues, Barani, and Kopitowski), and Institute of Clinical Effectiveness and Health Policy (Drs Adolfo Rubinstein and Fernando Rubinstein), Buenos Aires, Argentina.

Corresponding Author: Adolfo Rubinstein, MD, MSc, PhD, Division of Family and Community Medicine, Hospital Italiano de Buenos Aires, Gascón 450, Buenos Aires, C1181ACH, Argentina

The authors appreciate the assistance of Alejandro Lopez Osornio and Sergio Montenegro with the retrieval of data from the Hospital Italiano Health Information dataset. This research was partially funded by a scholarship to Mariela Barani from the National Commission of Health, Science and Technology (SACyT), Argentine Ministry of Health.

© 2009 Lippincott Williams & Wilkins, Inc.