• Henry J Michtalik, Howard T Carolan, Elliott R Haut, Brandyn D Lau, Michael B Streiff, Joseph Finkelstein, Peter J Pronovost, Nowella Durkin, and Daniel J Brotman.
• Department of Medicine, Johns Hopkins University, Baltimore, Maryland; Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland.
• J Hosp Med. 2015 Mar 1; 10 (3): 172178172-8.

BackgroundDespite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance and payment incentives through pay-for-performance programs.ObjectiveTo sequentially examine an individualized physician dashboard and pay-for-performance program to improve VTE prophylaxis rates among hospitalists.DesignRetrospective analysis of 3144 inpatient admissions. After a baseline observation period, VTE prophylaxis compliance was compared during both interventions.SettingA 1060-bed tertiary care medical center.ParticipantsThirty-eight part-time and full-time academic hospitalists.InterventionsA Web-based hospitalist dashboard provided VTE prophylaxis feedback. After 6 months of feedback only, a pay-for-performance program was incorporated, with graduated payouts for compliance rates of 80% to 100%.MeasurementsPrescription of American College of Chest Physicians' guideline-compliant VTE prophylaxis and subsequent pay-for-performance payments.ResultsMonthly VTE prophylaxis compliance rates were 86% (95% confidence interval [CI]: 85-88), 90% (95% CI: 88-93), and 94% (95% CI: 93-96) during the baseline, dashboard, and combined dashboard/pay-for-performance periods, respectively. Compliance significantly improved with the use of the dashboard (P = 0.01) and addition of the pay-for-performance program (P = 0.01). The highest rate of improvement occurred with the dashboard (1.58%/month; P = 0.01). Annual individual physician performance payments ranged from $53 to $1244 (mean $633; standard deviation ±$350).ConclusionsDirect feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program. Real-time dashboards and physician-level incentives may assist hospitals in achieving higher safety and quality benchmarks.© 2014 Society of Hospital Medicine.

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