0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Commentary |

Aligning Rewards With Large-Scale Improvement

Keith Evan Mandel, MD
JAMA. 2010;303(7):663-664. doi:10.1001/jama.2010.156.
Text Size: A A A
Published online

Extract

Intensified health care reform efforts increase the urgency to achieve significant improvements in quality and substantial cost savings at the national level. Yet the pace of executing and spreading effective improvement interventions makes it unlikely these outcomes will be achieved in the foreseeable future. Although frameworks for large-scale improvement have been described by the Institute of Medicine, Commonwealth Fund, and others, there is limited evidence about how to design and implement system changes that improve population-based quality measures while also overcoming challenges inherent to large-scale change. Even though there is increasing evidence from innovation networks, improvement collaboratives, and national improvement campaigns about what works, the likelihood of achieving regional, state, or national-level improvement goals is limited without disruptive strategies that accelerate large-scale diffusion of effective interventions.13 Shifting the focus to rewarding sites (eg, primary care practices, hospitals) based on first achieving population-based improvement goals represents a disruptive innovation with significant potential to accelerate the spread of evidence-based interventions, thus maximizing the effects on quality and costs at a national level.

Figures in this Article

Topics

reward

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure. Conceptual Model for Rewarding Large-Scale Improvement
Graphic Jump Location

The site-level eligibility criteria represent measurable behaviors that support achieving aggregate-level performance goals. The site-level performance targets are based on thresholds set higher than aggregate-level targets to reward outstanding performance.
Letters “a” and “b” correspond to the boxes at right.

Tables

References

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 3

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();