Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Pay for Performance Improves Quality Across Demographic Groups

Bhalla, Rohit MD, MPH; Schechter, Clyde B. MD, MA; Strelnick, A. H. MD; Deb, Nandini MA; Meissner, Paul MSPH; Currie, Brian P. MD, MPH

doi: 10.1097/QMH.0b013e31829a6b4f
Original Articles

Objective: To evaluate quality and the effect of pay for performance among minority patient groups, during a pay-for-performance program in 22 primary care practice sites.

Methods: Data were collected on 26 standardized measures of care for 2 measurement cycles. Proportions of recommended care received across 5 composite quality domains were analyzed by demographic group. Regression models including significant covariates were constructed. Adjusted odds ratios (ORs) were derived to assess the effect of pay of performance within demographic groups.

Results: Improvements were observed from 2007 to 2009 for all patients in each of 5 composite quality domains of diabetes, coronary artery disease, heart failure, screening and prevention, and all care. With the exception of heart failure care for Hispanic/Latino and Spanish language–preferring patients, improvement was observed in all domains for African American/black race, Hispanic/Latino ethnicity, and Spanish language–preferred groups. Following adjustment for covariates, pay for performance was associated with significant improvement in all-patient diabetes care (adjusted OR = 1.15; [95% confidence interval [CI], 1.09–1.22), screening and prevention (adjusted OR = 1.55; 95% CI, 1.41–1.69), and all care (adjusted OR = 1.27; 95% CI, 1.20–1.35). Significant improvements were also observed within the minority demographic groups noted earlier.

Conclusions: Pay-for-performance programs structured as additional incentive monies for providers improved care for all patients and among minority groups, in whom disparities have historically been observed.

Montefiore Medical Center (Drs Bhalla, Strelnick, and Currie, Ms Deb, and Mr Meissner) and Albert Einstein College of Medicine (Drs Bhalla, Schechter, Strelnick, and Currie and Mr Meissner), Bronx, New York.

Correspondence: Rohit Bhalla, MD, MPH, Stamford Hospital, P.O. Box 9317, 30 Shelburne Rd, Stamford, CT 06904 (

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Dr Schechter performed data analyses.

Funding for the pay-for-performance program was provided by a New York State Department of Health grant (program no. 0603130408, contract no. C022159). Funding for the evaluation was provided by a Robert Wood Johnson Foundation grant (no. 65449). The authors acknowledge the role of Cal Emery and Pamela McMaster in data acquisition.

All authors report having no conflicts of interest related to this article.

© 2013Wolters Kluwer Health | Lippincott Williams & Wilkins