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Physician Dashboards, Pay-for-Performance Deliver Better VTE Prophylaxis Rates


 

The combination of direct feedback from web-based physician dashboards and a pay-for-performance program “significantly improved” hospitalists’ compliance with VTE prophylaxis, according to a recent study in the Journal of Hospital Medicine.

In the report, hospitalist Henry Michtalik, MD, MPH, MHS, and colleagues noted that while physicians’ compliance increased most by using dashboards, the combination of the two methods is recommended to “combine extrinsic and intrinsic motivations.”

“They end up enhancing each other,” says Dr. Michtalik, associate faculty and international consultant at the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine in Baltimore. “I really don’t think you can have one without the other. If you have a pay-for-performance program without a dashboard, that’s the equivalent of driving down an unfamiliar highway without any signs. You’re not really sure where you were, you’re not really sure where you’re going, you think you’re on the right path, but you would sure feel a lot better if you had some markers along the way.”

The study analyzed 3,144 inpatient admissions at a tertiary-care medical center from 2009 to 2012. During the dashboard-only intervention period, providers improved compliance by 4% on average (95% CI, 3–5; P<0.001). With the addition of the pay-for-performance program, providers improved another 4% (95% CI, 3–5; P<0.001). Group compliance improved from 86% (95% CI, 85–88) during the baseline period to 90% (95% CI, 88–93) during the dashboard period (P=0.01) and 94% (95% CI, 93–96) during the pay-for-performance program (P=0.01).

Dr. Michtalik says that in an era of value-based purchasing and broader healthcare reform, most institutions are already collecting data on VTE prophylaxis. The next step, he says, should be bringing data to the provider level and making that an agent for change.

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