Summary of Pay-for-Performance Methodology

Define major data for uniform documentation within each specialty

Historical aspects

Symptoms

Signs

Physical findings

Laboratory data

Radiography

Diagnoses

Therapies

Outcomes

Factors influencing outcomes (confounders/risk adjustment)

Data recording and analysis

Modify electronic medical record to facilitate ongoing discipline-specific improvement efforts

Provide fields for structured data

Adopt standardized phraseology for unstructured charting (semistructured)

Allow customization/addition of new fields for structured data as needs arise

Develop temporal tags for structured entries

Facilitate

Simple, rapid query of structured and semistructured data by providers

Export of query results into database

Analysis of database data with statistical software

Indicator selection

Process measures with evidence-based link to favorable outcomes

Proposed by individuals and/or focus groups

Applicable for provider groups/departments

Review literature to confirm evidence base

Measurable

Valid

Reliable

Suboptimal past performance or new practice

Confounders defined and measurable (risk adjustment)

Sample size adequacy (number of patients, time periods for analyses)

Define anticipated magnitude of meaningful improvement

Implementation of practice change during interim period

Interventions to enhance performance

Continuous performance evaluation and feedback

Run/control charts

Bivariate statistics for before-and-after comparisons

Multivariate techniques to control for confounders

Define relationship between magnitude of improvement and remuneration