Table 3.

Comparison of options for measuring process or outcome quality in a performance-based financing programs (PBF) program

Method	Advantage	Disadvantage	Scope (efficiency; responsiveness and scalability)
Chart review	Readily available; currently practiced	Documentation is highly variable; Gaming is easy and Case mix is uncontrolled	Inefficient but responsive and scalable
Vignettes	Cases are standardized for benchmarking; inexpensive and readily scalable; can also be used for rare conditions	Limited experience in a PBF environment; concerns of ‘know-do’ gap; vignettes are a generic term and all vignettes are not the same	Efficient, responsive and scalable; linked to better outcomes
Direct observation	Assesses competency	Limited experience in a PBF environment, difficult to scale	Not efficient, however could be made responsive to key conditions, Difficult to scale
Mystery patient	Avoiding Hawthorne effect (‘Gold Standard’)	No experience in a PBF environment; limited range of conditions can be simulated; training and inter-rater reliability a challenge	Not efficient, difficult to make responsive, difficult to scale
Exit interview	Patient perspective on the care provided can be quantified providing information on effort	No experience in a PBF environment	Theoretically possible, but probably not practical due to PBF context. Doubtful efficient, doubtful responsive due to Hawthorn effect, difficult to scale
		Laborious review and analysis of data
		Hawthorne effect?
Client satisfaction survey	Information on patient opinion and appreciation	Recall is a problem	Probably efficient, can be made responsive, scalable
	Information on out of pocket payments	Design and testing of the instrument is crucial