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Programs that give physicians real-time feedback and financial incentives may lead to improvements in hospital safety, according to a study published in the Journal of Hospital Medicine.
The study showed that hospitalists significantly improved their compliance with practice guidelines for preventing venous thromboembolism (VTE)
when they could get feedback on their compliance rates and a direct financial incentive for improving their performance.
“Our study confirms there is a real return on investment in such programs, not only for patient safety but also for hospitals,” said study author Henry Michtalik, MD, of Johns Hopkins Hospital in Baltimore, Maryland.
“Metrics such as the use of preventive drugs for [VTE] are already being monitored but only really improve a hospital’s quality of care when programs get data back to the people who are treating patients to directly improve care.”
Dr Michtalik and his team found that, by providing such information to physicians through web-based, real-time displays, monthly VTE prophylaxis compliance rates improved from 86% to 90% in 6 months.
Adding pay-for-performance to the real-time feedback for the following 18 months boosted compliance rates to 94%.
Dr Michtalik pointed out that “no one got wealthy off of the pay-for-performance program. Instead, we believe the money served more as a method to engage the providers.”
Payments ranged from $53 to $1244, with all but 2 of the incentive payments totaling under $1000. And it was during the 6-month feedback-only period that compliance rose the fastest.
The study involved 38 part-time and full-time academic hospitalists and the analysis of 3144 inpatients with a median stay of 3 days. The most common diagnoses were heart failure, acute kidney failure, temporary loss of consciousness (syncope), pneumonia, and chest pain.
Following the evidence-based guidelines of the American College of Chest Physicians for VTE prevention, physicians in the study were required to complete a VTE-risk assessment for each patient by using the hospital’s computerized provider order entry system.
“It sort of walks you through the thinking process” for making the VTE-risk assessment, Dr Michtalik said.
The system then prompted physicians with a risk-appropriate recommendation, but it was up to physicians to order the treatment itself. That allowed for physician discretion among types of prevention, as well as for patient and physician preference.
Before implementing the feedback system, the researchers established a 2-year baseline and found that physicians in the study prescribed inappropriate prophylaxis 7.9% of the time and did not prescribe prophylaxis when indicated 6.1% of the time.
Overall, the choice of inappropriate preventive treatment dropped to 6.2% with real-time feedback and to 2.6% with the addition of pay-for-performance. Lack of prophylaxis when indicated fell to 3.2% with feedback and to 3.1% with pay-for-performance.
Dr Michtalik noted that continuous improvements depend not only on the right kind of feedback but also on efforts to avoid “information overload,” especially now that an increasing amount of health and medical records are electronic.
“So you specifically target a few things that need to be improved,” he said, “and really incorporate them into the hospital’s culture.” 
Photo courtesy of CDC
Programs that give physicians real-time feedback and financial incentives may lead to improvements in hospital safety, according to a study published in the Journal of Hospital Medicine.
The study showed that hospitalists significantly improved their compliance with practice guidelines for preventing venous thromboembolism (VTE)
when they could get feedback on their compliance rates and a direct financial incentive for improving their performance.
“Our study confirms there is a real return on investment in such programs, not only for patient safety but also for hospitals,” said study author Henry Michtalik, MD, of Johns Hopkins Hospital in Baltimore, Maryland.
“Metrics such as the use of preventive drugs for [VTE] are already being monitored but only really improve a hospital’s quality of care when programs get data back to the people who are treating patients to directly improve care.”
Dr Michtalik and his team found that, by providing such information to physicians through web-based, real-time displays, monthly VTE prophylaxis compliance rates improved from 86% to 90% in 6 months.
Adding pay-for-performance to the real-time feedback for the following 18 months boosted compliance rates to 94%.
Dr Michtalik pointed out that “no one got wealthy off of the pay-for-performance program. Instead, we believe the money served more as a method to engage the providers.”
Payments ranged from $53 to $1244, with all but 2 of the incentive payments totaling under $1000. And it was during the 6-month feedback-only period that compliance rose the fastest.
The study involved 38 part-time and full-time academic hospitalists and the analysis of 3144 inpatients with a median stay of 3 days. The most common diagnoses were heart failure, acute kidney failure, temporary loss of consciousness (syncope), pneumonia, and chest pain.
Following the evidence-based guidelines of the American College of Chest Physicians for VTE prevention, physicians in the study were required to complete a VTE-risk assessment for each patient by using the hospital’s computerized provider order entry system.
“It sort of walks you through the thinking process” for making the VTE-risk assessment, Dr Michtalik said.
The system then prompted physicians with a risk-appropriate recommendation, but it was up to physicians to order the treatment itself. That allowed for physician discretion among types of prevention, as well as for patient and physician preference.
Before implementing the feedback system, the researchers established a 2-year baseline and found that physicians in the study prescribed inappropriate prophylaxis 7.9% of the time and did not prescribe prophylaxis when indicated 6.1% of the time.
Overall, the choice of inappropriate preventive treatment dropped to 6.2% with real-time feedback and to 2.6% with the addition of pay-for-performance. Lack of prophylaxis when indicated fell to 3.2% with feedback and to 3.1% with pay-for-performance.
Dr Michtalik noted that continuous improvements depend not only on the right kind of feedback but also on efforts to avoid “information overload,” especially now that an increasing amount of health and medical records are electronic.
“So you specifically target a few things that need to be improved,” he said, “and really incorporate them into the hospital’s culture.”
Photo courtesy of CDC
Programs that give physicians real-time feedback and financial incentives may lead to improvements in hospital safety, according to a study published in the Journal of Hospital Medicine.
The study showed that hospitalists significantly improved their compliance with practice guidelines for preventing venous thromboembolism (VTE)
when they could get feedback on their compliance rates and a direct financial incentive for improving their performance.
“Our study confirms there is a real return on investment in such programs, not only for patient safety but also for hospitals,” said study author Henry Michtalik, MD, of Johns Hopkins Hospital in Baltimore, Maryland.
“Metrics such as the use of preventive drugs for [VTE] are already being monitored but only really improve a hospital’s quality of care when programs get data back to the people who are treating patients to directly improve care.”
Dr Michtalik and his team found that, by providing such information to physicians through web-based, real-time displays, monthly VTE prophylaxis compliance rates improved from 86% to 90% in 6 months.
Adding pay-for-performance to the real-time feedback for the following 18 months boosted compliance rates to 94%.
Dr Michtalik pointed out that “no one got wealthy off of the pay-for-performance program. Instead, we believe the money served more as a method to engage the providers.”
Payments ranged from $53 to $1244, with all but 2 of the incentive payments totaling under $1000. And it was during the 6-month feedback-only period that compliance rose the fastest.
The study involved 38 part-time and full-time academic hospitalists and the analysis of 3144 inpatients with a median stay of 3 days. The most common diagnoses were heart failure, acute kidney failure, temporary loss of consciousness (syncope), pneumonia, and chest pain.
Following the evidence-based guidelines of the American College of Chest Physicians for VTE prevention, physicians in the study were required to complete a VTE-risk assessment for each patient by using the hospital’s computerized provider order entry system.
“It sort of walks you through the thinking process” for making the VTE-risk assessment, Dr Michtalik said.
The system then prompted physicians with a risk-appropriate recommendation, but it was up to physicians to order the treatment itself. That allowed for physician discretion among types of prevention, as well as for patient and physician preference.
Before implementing the feedback system, the researchers established a 2-year baseline and found that physicians in the study prescribed inappropriate prophylaxis 7.9% of the time and did not prescribe prophylaxis when indicated 6.1% of the time.
Overall, the choice of inappropriate preventive treatment dropped to 6.2% with real-time feedback and to 2.6% with the addition of pay-for-performance. Lack of prophylaxis when indicated fell to 3.2% with feedback and to 3.1% with pay-for-performance.
Dr Michtalik noted that continuous improvements depend not only on the right kind of feedback but also on efforts to avoid “information overload,” especially now that an increasing amount of health and medical records are electronic.
“So you specifically target a few things that need to be improved,” he said, “and really incorporate them into the hospital’s culture.”