Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis

Henry J. Michtalik, Howard T. Carolan, Elliott R. Haut, Brandyn D. Lau, Michael B. Streiff, Joseph Finkelstein, Peter J. Pronovost, Nowella Durkin, Daniel J. Brotman

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)172-178
Number of pages7
JournalJournal of hospital medicine
Volume10
Issue number3
DOIs
StatePublished - Mar 1 2015

ASJC Scopus subject areas

  • Leadership and Management
  • Internal Medicine
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

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