Published online May 1, 2007
PEDIATRICS Vol. 119 No. 5 May 2007, pp. 975-982 (doi:10.1542/peds.2006-1565)
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SPECIAL ARTICLE

Implementing Pay-for-Performance in the Neonatal Intensive Care Unit

Jochen Profit, MD, MPHa,b, John A. F. Zupancic, MD, ScDc, Jeffrey B. Gould, MD, MPHd,e and Laura A. Petersen, MD, MPHb,f

a Section of Neonatology, Texas Children's Hospital
f Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
b Houston Center for Quality of Care and Utilization Studies, Houston Veterans Affairs Medical Center, Houston, Texas
c Harvard Neonatal Perinatal Medicine Program, Beth Israel Deaconess Medical Center, Boston, Massachusetts
d California Perinatal Quality Care Collaborative, Palo Alto, California
e Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, California

Pay-for-performance initiatives in medicine are proliferating rapidly. Neonatal intensive care is a likely target for these efforts because of the high cost, available databases, and relative strength of evidence for at least some measures of quality. Pay-for-performance may improve patient care but requires valid measurements of quality to ensure that financial incentives truly support superior performance. Given the existing uncertainty with respect to both the effectiveness of pay-for-performance and the state of quality measurement science, experimentation with pay-for-performance initiatives should proceed with caution and in controlled settings. In this article, we describe approaches to measuring quality and implementing pay-for-performance in the NICU setting.

Key Words: pay-for-performance programs • quality improvement

Abbreviations: QI—quality improvement • IOM—Institute of Medicine • OECD—Organisation of Economic Cooperation and Development • CPQCC—California Perinatal Quality Care Collaborative

Accepted Dec 20, 2007.




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A. T. Chien and R. A. Dudley
Pay-for-Performance in Pediatrics: Proceed With Caution
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