Pay for Performance Alone Cannot Drive Quality

OBJECTIVE: To determine whether aligning design characteristics of a pay-for-performance program with objectives of an asthma improvement collaborative builds improvement capability and accelerates improvement. DESIGN: Interrupted time series analysis of the impact of pay for performance on results of an asthma improvement collaborative. SETTING: Forty-four pediatric practices within greater Cincinnati. PARTICIPANTS: Forty-four pediatric practices with 13 380 children with asthma. INTERVENTIONS: The pay-for-performance program rewarded practices for participating in the collaborative, achieving network- and practice-level performance thresholds, and building improvement capability. Pay for performance was coupled with additional improvement interventions related to the collaborative. OUTCOME MEASURES: Flu shot percentage, controller medication percentage for children with persistent asthma, and written self-management plan percentage. RESULTS: The pay-for-performance program provided each practice with…