Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3033 — Results of a Team-Oriented Pay-for-Performance (TOPP) Program to Improve Clinical Performance and Patient Outcomes in VHA

Guihan M (Hines) , Weiss K (Hines), Temeck B (Hines)

Objectives:
To describe the results of a pilot study to assess whether a team-oriented pay for performance (TOPP) incentive program leads to improved quality and better patient outcomes.

Methods:
A pre-post test design was used to study the TOPP approach. Five teams (consisting of up to 10 physicians, nursing, allied health professionals and/or administrative/support staff) at 2 sites in VISN 12 focused on making improvements in clinical outcomes and/or administrative measures. Only teams working in areas where facility performance measures were well-below national benchmarks were eligible to participate in TOPPs. The chiefs of staff agreed to an incentive award for all members (not to exceed $5K per team) if the team met its target. Teams were studied before and after six months of the TOPPs intervention. Outcomes included: 1) Change in performance measure. Outcomes include changes in VHA approved clinical (e.g., hypertension management) and administrative (e.g., wait times for new appointments, missed/cancelled clinic appointments, bed days of care, days on diversion) performance measures. Teams were required to identify a specific target at the inception of TOPP. EPRP and/or clinical reminder roll-up data were used to compare pre/post-TOPPs measures. 2) Team Function. To better understand the teams, barriers they encountered, and strategies used, semi-structured interviews were conducted with team personnel.

Results:
Three of five teams were successful in achieving their target goals. One team achieved its target but did not recruit enough patients. Participants expressed great enthusiasm about this approach to performance improvement. Common strategies included asserting the right to ask questions of other staff, collecting their own data, involving hospital Performance Improvement staff with the team, delving more deeply into the problem, frequent meetings between team members to address issues, and comparing the effectiveness of multiple strategies.

Implications:
Based on the results of this pilot study, a team oriented pay for performance strategy may be an effective strategy to improve performance measures. The next step would be to assess this program in a more generalizable study that includes appropriate comparison groups.

Impacts:
Preliminary results indicate that this is a robust approach to improving quality in VA.