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. 2017 Jun 5;17(1):385.
doi: 10.1186/s12913-017-2333-x.

Characterization and effectiveness of pay-for-performance in ophthalmology: a systematic review

Tim Herbst  1 , Martin Emmert  2
Affiliations

Characterization and effectiveness of pay-for-performance in ophthalmology: a systematic review

Tim Herbst et al. BMC Health Serv Res. .

Abstract

Background: To identify, characterize and compare existing pay-for-performance approaches and their impact on the quality of care and efficiency in ophthalmology.

Methods: A systematic evidence-based review was conducted. English, French and German written literature published between 2000 and 2015 were searched in the following databases: Medline (via PubMed), NCBI web site, Scopus, Web of Knowledge, Econlit and the Cochrane Library. Empirical as well as descriptive articles were included. Controlled clinical trials, meta-analyses, randomized controlled studies as well as observational studies were included as empirical articles. Systematic characterization of identified pay-for-performance approaches (P4P approaches) was conducted according to the "Model for Implementing and Monitoring Incentives for Quality" (MIMIQ). Methodological quality of empirical articles was assessed according to the Critical Appraisal Skills Programme (CASP) checklists.

Results: Overall, 13 relevant articles were included. Eleven articles were descriptive and two articles included empirical analyses. Based on these articles, four different pay-for-performance approaches implemented in the United States were identified. With regard to quality and incentive elements, systematic comparison showed numerous differences between P4P approaches. Empirical studies showed isolated cost or quality effects, while a simultaneous examination of these effects was missing.

Conclusion: Research results show that experiences with pay-for-performance approaches in ophthalmology are limited. Identified approaches differ with regard to quality and incentive elements restricting comparability. Two empirical studies are insufficient to draw strong conclusions about the effectiveness and efficiency of these approaches.

Keywords: Ophthalmology; P4P; Pay for performance; Systematic comparison.

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Figures

Fig. 1
Fig. 1
search flow and results A systematic review of published literature was conducted in electronic data bases. After elimination of duplicates, title and abstracts of the remaining papers were reviewed. 24 full texts were reviewed leading to 13 articles, which were finally included
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