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Relationship Between Organizational Factors and Performance Among Pay-for-Performance Hospitals

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ABSTRACT

BACKGROUND

The Centers for Medicare & Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) project aims to improve clinical performance through a pay-for-performance program. We conducted this study to identify the key organizational factors associated with higher performance.

METHODS

An investigator-blinded, structured telephone survey of eligible hospitals’ (N = 92) quality improvement (QI) leaders was conducted among HQID hospitals in the top 2 or bottom 2 deciles submitting performance measure data from October 2004 to September 2005. The survey covered topics such as QI interventions, data feedback, physician leadership, support for QI efforts, and organizational culture.

RESULTS

More top performing hospitals used clinical pathways for the treatment of AMI (49% vs. 15%, p < 0.01), HF (44% vs. 18%, p < 0.01), PN (38% vs. 13%, p < 0.01) and THR/TKR (56% vs. 23%, p < 0.01); organized into multidisciplinary teams to manage patients with AMI (93% vs. 77%, p < 0.05) and HF (93% vs. 69%, p < 0.01); used order sets for the treatment of THR/TKR (91% vs. 64%, p < 0.01); and implemented computerized physician order entry in the hospital (24.4% vs. 7.9%, p < 0.05). Finally, more top performers reported having adequate human resources for QI projects (p < 0.01); support of the nursing staff to increase adherence to quality indicators (p < 0.01); and an organizational culture that supported coordination of care (p < 0.01), pace of change (p < 0.01), willingness to try new projects (p < 0.01), and a focus on identifying system errors rather than blaming individuals (p < 0.05).

CONCLUSIONS

Organizational structure, support, and culture are associated with high performance among hospitals participating in a pay-for-performance demonstration project. Multiple organizational factors remain important in optimizing clinical care.

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Acknowledgments

We gratefully acknowledge the assistance of Premier, Inc. in providing the administrative data for this research. This study was self-funded by Zynx Health, Inc. The investigators retained control over all aspects of the survey data, analyses, and presentation of results. The views expressed in this article are those of the authors and do not necessarily represent the views of Zynx Health Inc. or Premier Inc. Portions of this study have been presented at the AcademyHealth Annual Research Meeting, June 2008.

Conflict of Interest

Dr. Vina was a health services research fellow at Cedars-Sinai Medical Center and Zynx Health Incorporated. Mr. Weingarten was an employee of Zynx Health Incorporated. Drs. Rhew, Weingarten, and Chang are employees of Zynx Health Incorporated.

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Correspondence to John T. Chang MD, PhD, MPH.

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Vina, E.R., Rhew, D.C., Weingarten, S.R. et al. Relationship Between Organizational Factors and Performance Among Pay-for-Performance Hospitals. J GEN INTERN MED 24, 833–840 (2009). https://doi.org/10.1007/s11606-009-0997-6

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