gms | German Medical Science

15. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

5. - 7. Oktober 2016, Berlin

Performance Management Systeme: Einfluss externer und organisationaler Faktoren auf die Implementierung in Arztpraxen

Meeting Abstract

  • Alexander Pimperl - University of California, Berkeley, School of Public Health -­ Health Policy and Management, Berkeley, USA
  • Hector Rodriguez - University of California, Berkeley, School of Public Health -­ Health Policy and Management, Berkeley, USA
  • Julie Schmittdiel - Kaiser Permanente Northern California, Division of Research, Oakland, USA
  • Stephen Shortell - University of California, Berkeley, School of Public Health -­ Health Policy and Management, Berkeley, USA

15. Deutscher Kongress für Versorgungsforschung. Berlin, 05.-07.10.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocFV05

doi: 10.3205/16dkvf057, urn:nbn:de:0183-16dkvf0575

Veröffentlicht: 28. September 2016

© 2016 Pimperl et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Background: Performance management systems (PMS) are an important tool to improve the performance (quality, efficiency, etc.) of physician organizations. But sparse information exists about the extent to which physician organizations have implemented PMS and the factors associated with the development and maintenance of PMS.

Research Objective: The aim of this study is to examine which organizational capabilities and external factors are associated with the implementation of PMS in physician organizations and to shed light on the extent to which US physician organizations have implemented PMS.

Methods: We constructed a 14-item composite PMS index from US physician organization survey data using principal factors analysis. The PMS index consists of four subcomponents: 1) performance feedback for chronic conditions, 2) and/or for preventive services, 3) PMS integration into the information technology (IT) system, 4) regular review, update and established continuous quality improvement process. Linear regression estimated the impact of organizational characteristics, internal mechanisms and contextual factors on physician organizations’ PMS index.

The third National Survey of Physician Organizations (NSPO3), a nationally representative sample of physician practices (n=1,398, response rate = 49.7%), were analyzed. Data on physician organization characteristics, chronic care management processes, ACO participation, and other variables were collected via a 40-minute phone survey from January 2012–Nov 2013. We excluded organizations with missing values, resulting in an analytic sample of 1,328 practices. All analyses were weighted.

Results: On average, US practices used only 26.3% (interquartile range= 43.8% - 0%) of the PMS processes measured in the PMS index. In adjusted analyses, practices participating in an Accountable Care Organization (ACO), larger and multispecialty practices, those with greater health information technology (HIT) functionality and electronic chronic disease registries, those that receive data on the quality of care from health plans or are evaluated by external entities had significantly higher PMS index scores. Practices receiving a significant proportion of patients from an independent practice association IPA and/or physician-hospital organization (PHO) had less developed PMS, compared to practices that do not get patients from these sources and instead solely get patients from their medical group or stand-alone practice. After considering practice use of performance feedback provided to the practice by an IPA and/or IPO as an extension of the PMS index, practices receiving patients from an IPA and/or PHO had more developed PMS than unaffiliated practices, highlighting potential roles of IPA and PHOs in facilitating PMS development. External pay-for-performance (P4P) incentives were unrelated to PMS.

Discussion: US physician organizations with more developed PMS tend to be larger or part of a network, be subject to external reporting requirements, and have greater HIT capabilities to facilitate the development of performance management structures and processes. Although these findings are based in the U.S., the findings may generalize to physician practices and networks in other countries. Further in-depth analysis of specific PMS best-practices provides a natural opportunity for researchers to explain variation in PMS development and use.

Implications for Policy or Practice: ACOs, IPAs/PHOs and other organizational networks may enable practices to implement and use PMS to improve performance. Incentives promoted by ACOs or other networks, as well as being subject to external reporting requirements may have a bigger impact on the development and use of internal PMS than direct external financial incentives (i.e. pay-for-performance). Policies to improve performance management in health care should consider these associations.