The impact of Value Incentive Program (VIP) on the quality of hospital care for acute stroke in Korea

Abstract

Objectives: This study aims to analyze the impact of Value Incentive Program (VIP) on the quality improvement of acute stroke care, and to determine the difference of effect by the size of hospitals.

Interventions: Adopting the VIP on the fifth acute stroke quality assessment.

Design/setting/participants: Using paired t-test and student t-test, we compared the quality assessment results of the third assessment, which was publicly reported without the VIP implementation and the fifth assessment, on which the VIP was applied. The subjects of the third assessment were acute stroke admissions in 201 hospitals (44 tertiary and 157 general hospitals) from January to March 2010. The fifth assessment included 201 hospitals (42 tertiary and 159 general hospitals) from March to May 2013.

Main outcome measures: Seven process indicators of acute stroke quality assessment and in-hospital mortality rate.

Result: In comparison to the third assessment, five of the seven process indicators showed statistically significant improvement in the fifth assessment. Also, there were significant decreases in the interquartile ranges of five process indicators. This phenomenon was more notable in general hospitals. The in-hospital mortality rate of hemorrhagic stroke in general hospitals showed a statistically significant decrease from 20.8% in the third assessment to 11.6% (P < 0.05) in the fifth assessment.

Conclusion: This study demonstrated that the VIP was effective in improving quality of acute stroke care. The improvement was more prominent in general hospitals, and led to reduced quality gaps among hospitals.

Keywords: Health Insurance Review and Assessment Service; acute stroke quality assessment; health care quality indicators; pay for performance; quality improvement.