Document Detail

Reduced mortality with hospital pay for performance in England.
MedLine Citation:
PMID:  23134382     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Pay-for-performance programs are being adopted internationally despite little evidence that they improve patient outcomes. In 2008, a program called Advancing Quality, based on the Hospital Quality Incentive Demonstration in the United States, was introduced in all National Health Service (NHS) hospitals in the northwest region of England (population, 6.8 million).
METHODS: We analyzed 30-day in-hospital mortality among 134,435 patients admitted for pneumonia, heart failure, or acute myocardial infarction to 24 hospitals covered by the pay-for-performance program. We used difference-in-differences regression analysis to compare mortality 18 months before and 18 months after the introduction of the program with mortality in two comparators: 722,139 patients admitted for the same three conditions to the 132 other hospitals in England and 241,009 patients admitted for six other conditions to both groups of hospitals.
RESULTS: Risk-adjusted, absolute mortality for the conditions included in the pay-for-performance program decreased significantly, with an absolute reduction of 1.3 percentage points (95% confidence interval [CI], 0.4 to 2.1; P=0.006) and a relative reduction of 6%, equivalent to 890 fewer deaths (95% CI, 260 to 1500) during the 18-month period. The largest reduction, for pneumonia, was significant (1.9 percentage points; 95% CI, 0.9 to 3.0; P<0.001), with nonsignificant reductions for acute myocardial infarction (0.6 percentage points; 95% CI, -0.4 to 1.7; P=0.23) and heart failure (0.6 percentage points; 95% CI, -0.6 to 1.8; P=0.30).
CONCLUSIONS: The introduction of pay for performance in all NHS hospitals in one region of England was associated with a clinically significant reduction in mortality. As compared with a similar U.S. program, the U.K. program had larger bonuses and a greater investment by hospitals in quality-improvement activities. Further research is needed on how implementation of pay-for-performance programs influences their effects. (Funded by the NHS National Institute for Health Research.).
Matt Sutton; Silviya Nikolova; Ruth Boaden; Helen Lester; Ruth McDonald; Martin Roland
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  367     ISSN:  1533-4406     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-08     Completed Date:  2012-11-19     Revised Date:  2013-03-07    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1821-8     Citation Subset:  AIM; IM    
Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, United Kingdom.
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MeSH Terms
England / epidemiology
Heart Failure / mortality*
Hospital Mortality*
Logistic Models
Myocardial Infarction / mortality*
Pneumonia / mortality*
Reimbursement, Incentive*
Risk Adjustment
State Medicine*
Comment In:
N Engl J Med. 2012 Nov 8;367(19):1852-3   [PMID:  23134388 ]
N Engl J Med. 2013 Mar 7;368(10):968   [PMID:  23465117 ]
N Engl J Med. 2013 Mar 7;368(10):968-9   [PMID:  23465118 ]
N Engl J Med. 2013 Mar 7;368(10):969   [PMID:  23465116 ]

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