The continuing adoption of quality-based financial incentives for physicians has heightened the? need for empirical study. Whereas such pay-for-quality (P4Q) programs are relatively new to the? health services industry, they have long existed in other sectors of the economy. Data from the? ?Rewarding Results? demonstration project present an opportunity for empirical evaluation of? providers? attitudes and behavioral responses to a P4Q program. This dissertation project is a? convenience experiment that will use survey and administrative data to analyze associations? between primary care physicians? (PCPs?) attitudes to P4Q, and post-incentive changes in? adherence to targeted clinical behaviors. The study shall also suggest designs for P4Q incentives? that are attitude- and context-specific based on a multivariable model that explicitly links? provider attitudes with changes in their adherence to financially-incentivized, evidence-based,? and routine clinical tasks. We will link secondary data from an AHRQ-funded cross-sectional? survey on physician attitudes towards P4Q incentives with prospective administrative data on the? physicians? adherence to clinical guidelines. The study sample were primary care physicians? (PCPs) participating in the ?Value of Care? collaborative P4Q initiative of the Rochester? Independent Practice Association (RIPA) and Excellus-Blue Choice HMO. We will build on the? physician attitudes towards P4Q scale that was developed and validated from the original? ?Rewarding Results? physician survey. We will investigate the ability of context-specific? provider attitudes along seven core dimensions to predict post-incentive changes in adherence to? clinical guidelines that are targeted by financial rewards. The seven dimensions of physician P4Q? attitudes are awareness, relevance, impact, control, cooperation, salience, and unintended? consequences. Using a conceptual framework that is a modification of the theory of planned? behavior (TPB), and the empirical methods of multiple discriminant analysis and structural? equation modeling, we will determine a multivariable model of provider performance, adjusting? for the practice setting and physician characteristics. The resulting ?Provider P4Q Attitudes and? Performance Model? will yield new evidence, on the association between attitudes and? behavioral response to explicit P4Q financial incentives. The findings shall be directly relevant? to policy framers, health plan managers, hospital administrators, physician group executives,? PCPs, patients, researchers, and other stakeholders.
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