Component | Elements | Design options | Design choices P4P program |
---|---|---|---|
Performance measurement | Performance indicators | Â | Â |
 | Domains, subjects and indicators | Selection of:- Clinical care (diabetes, asthma, COPD, cardiovascular risk management, influenza vaccination, cervical cancer screening, prescribing acid suppressive drugs and antibiotics)- Practice management (infrastructure, team, information, quality and safety)- Patient experience (experience with general practitioner and organisation of care) | Selected indicators for:- Clinical care: diabetes (n = 9), asthma (n = 4), COPD (n = 5), cardiovascular risk management (n = 9), influenza vaccination (n = 2), cervical cancer screening (n = 1), prescribing antibiotics (n = 2)- Practice management: infrastructure (n = 7), team (n = 8), information (n = 3), quality and safety (n = 4)- Patient experience: experience with general practitioner (n = 16) and organisation of care (n = 11) |
 | Period of data collection | Data collection for all three domains each year vs. a trimmed-down version of the program | At baseline measurement of clinical care, practice management, patient experience; In following years only clinical care and patient experience |
Appraisal | Unit of assessment | Individual GP vs. general practice vs. larger organisational unit | General practice |
 | Performance standards | • Absolute vs. relative standards • Same standards vs. different standards for indicators/subjects | • A relative standard set at the 25th percentile of group performance • Different standards for indicators |
 | Analysis and interpretation of performance data |  |  |
 | Weighing the domains | Different weights vs. same weight | Clinical care : practice management : patient experience 2:1:1 |
 | Weighing the indicators | Different weights vs. same weight | Same weight for all indicators |
 | Calculations | • Separate scores for each domain vs. one overall domain-score • Calculations for quality level and/or improvement of performance | • Separate scores for each domain • Calculations for both quality level and improvement of performance |
 | Weighing the quality scores | Different weights vs. same weight for quality level and improvement of performance | Quality level : improvement of performance 3:1 |
 | Differentiation of quality scores | 4 levels vs. 5-7 levels vs. 8-10 levels | 7 levels |
 | Feedback | • Benchmark: median vs. best practice (75th or 90th percentile) vs. a combination • Risk adjustment: indirect vs. direct correction • One-step procedure vs. two-step procedure | • 25th percentile, median, 75th percentile • No risk adjustment • Two-step procedure |
Reimbursement | Financial rewards | Â | Â |
 | Payment | Money vs. human resources vs. sabbatical leave vs. a combination | Money |
 | Size of the bonus | 5000 Euros to 10000 Euros (5-10% practice income) on average per practice (depending on practice size) → appropriate or not? | 5000 Euros to 10000 Euros on average per practice (depending on practice size)Baseline: A maximum of euro 6.89 on average per patient*Following years: A maximum of euro 2.88 on average per patient* |
 | Spending the bonus | No obligations vs. obligations (spending for practice with or without pre-set goal) vs. a combination | No obligations |