The influence of year-end bonuses on colorectal cancer screening

The objective of the paper is to estimate the effect of physician bonus eligibility on CRC screening while controlling for patient and primary care physician characteristics. The study is retrospective, using a managed care plan’s claims data on fifty-year-old commercially insured patients in the years 2000 and 2001. The data also include links to enrollment and provider files. Multivariate logistic regression models are used to assess the association between CRC screening receipt and physician bonus eligibility. The results indicate that the probability that a patient received a CRC screening was approximately 3 percentage points higher in the year physicians were eligible for a bonus. There were also significant differences according to the gender of both the patient and physician, income, and race.

Demographic and Clinical Characteristics of Mucinous Epithelial Ovarian Cancer, and Survival Following a Mucinous Epithelial Ovarian Cancer Diagnosis

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The influence of year-end bonuses on colorectal cancer screening.

OBJECTIVE: To estimate the effect of physician bonus eligibility on colorectal cancer (CRC) screening, controlling for patient and primary care physician characteristics. STUDY DESIGN: Retrospective study using managed care plan claims data from 2000 and 2001. METHODS: Data on 50-year-old commercially insured patients in a managed care health plan were linked to enrollment and provider files. The data included information on 6749 patients (3058 in 2000 and 3691 in 2001). Multivariate logistic regression models were used to assess the association between CRC screening receipt and physician bonus eligibility. RESULTS: From 2000 to 2001, CRC screening use increased from 23.4% to 26.4% (P \u3c .01). Results from the multivariate logistic regression analysis revealed that the probability that a patient received a CRC screening was approximately 3 percentage points higher in the bonus year, 2001 (P \u3c .01). CONCLUSIONS: Bonuses targeted at individual physicians were associated with increased use of CRC screening tests. However, more research is needed to examine the effect of performance-based incentives on resource use and the quality of medical care. Specifically, there is a need to determine whether explicit financial incentives are effective in reducing racial disparities in the quality of patient care. This has particular relevance for CRC screening given that black patients are less likely to be screened, they have higher CRC incidence and mortality rates compared with other racial groups, and screening has been shown to be more cost effective in this population

Validation of the Pneumonia Severity Index Among Patients Treated at Home or in the Hospital

Objective: To assess the predictive validity of the pneumonia severity-of-illness index (PSI), a mortality prediction rule, and extend the work of others by including data on outpatients treated for pneumonia. Methods: Prospective study of 675 consecutive patients with community-acquired pneumonia (CAP) [501 inpatients and 174 outpatients] treated at primary care practice clinics or emergency departments at nine medical centers (five community healthcare systems, three university-affiliated hospital systems, and one Veterans Affairs Medical Center) in Georgia and Virginia in the US between November 1996 and March 1998. Data, including demographic characteristics, co-morbid conditions, laboratory and chest x-ray results, were collected from surveys administered to patients at inception, 2, 15, and 30 days and from retrospective medical chart review. We computed the PSI for each patient using demographic and prognostic factors including age, gender, co-existing illnesses, vital signs, laboratory test results and the corresponding logistic regression parameters from previous research. In addition, the Pneumonia Outcomes Research Team (PORT) prediction rule was used to risk adjust patients for mortality severity by disposition. Results: The PSI performed well in its ability to predict mortality for our sample of patients with an area under the Receiver Operating Curve (ROC) of 0.757, significantly different than chance (pCommunity-acquired-pneumonia, Pneumonia, Risk-factors

Chapter Demographic and Clinical Characteristics of Mucinous Epithelial Ovarian Cancer, and Survival Following a Mucinous Epithelial Ovarian Cancer Diagnosis

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