Partnership effectiveness in primary community care networks: A national empirical analysis of partners' coordination infrastructure designs

Incentives for physician teams: Effectiveness of performance feedback and payment distribution methods

Best practices in team-based incentive design remain underexplored. This study examines under group-based pay-for-performance, how managers incentivize physicians for teamwork through internal feedback and payment distribution methods. In collaboration with Taiwan Association of Family Medicine, authors conducted a national survey of physician groups, with a response rate of 48.3%. Multilevel linear regression was applied to 134 groups, collectively consisting of 1,245 physicians in Taiwan. The outcome variables were two manager-rated scores for group performance on achieving (a) comprehensive, coordinated, continuous care, and (b) patient health improvement. The results indicate that providing each physician feedback on peer performance is superior to not providing it; when providing peer information within a group, concealing identities is superior to revealing them. These findings imply that application of the principle of social comparison can be effective; however, caution should be taken when disclosure of identifiable peer performance may intensify peer competition and undermine care coordination in team-based models. Further, groups that distribute payments equally among physicians perform better than groups that distributed payment proportionally to physicians' patient shares. The findings are germane to small teams, where physicians do not have full control over care processes and outcomes, and need to work cooperatively to maximize group-based payment.

Determinants of knowledge-sharing networks in primary care

BACKGROUND

Around the world, health reforms are increasingly fostering collaboration and integration among primary care physicians with the aim of facilitating knowledge sharing and evidence-informed decision-making. Although extant research on this topic is abundant, the evidence and results regarding social and organizational factors affecting the formation of knowledge-sharing networks in this setting are inconclusive.

PURPOSE

The aim of this article is to explore multiple theoretical mechanisms explaining the formation of knowledge-sharing networks among primary care physicians across relevant clinical areas.

METHODOLOGY/APPROACH

The data are collected from two local health authorities in the Italian National Health Service that are responsible for delivering primary care in two Italian regions. Exponential random graph models are used to test the hypotheses.

FINDINGS

Our findings indicate that knowledge-sharing networks are highly correlated across clinical areas. In addition, knowledge-sharing networks are highly reciprocal and clustered. We also observe that formal models adopted to foster collaboration have remarkably different effects on the formation of knowledge networks, depending upon the diverse knowledge management approaches adopted in the surveyed local health authorities.

PRACTICE IMPLICATIONS

Primary care organizations need to develop and implement knowledge management practices in order to help physicians in identifying knowledge domain experts as well as to support connections through formal groupings and incentives.

Understanding Facilitators and Barriers to Care Transitions: Insights from Project ACHIEVE Site Visits

BACKGROUND

Care transitions between clinicians or settings are often fragmented and marked by adverse events. To increase patient safety and deliver more efficient and effective health care, new ways to optimize these transitions need to be identified. A study was conducted to delineate facilitators and barriers to implementation of transitional care services at health systems that may have been adopted or adapted from published evidence-based models.

METHODS

From March 2015 through December 2015, site visits were conducted across the United States at 22 health care organizations-community hospitals, academic medical centers, integrated health systems, and broader community partnerships. At each site, direct observation and document review were conducted, as were semistructured interviews with a total of 810 participants (5 to 57 participants per site) representing various stakeholder groups, including management and leadership, transitional care team members, internal stakeholders, community partners, patients, and family caregivers.

RESULTS

Facilitators of effective care transitions included collaborating within and beyond the organization, tailoring care to patients and caregivers, and generating buy-in among staff. Commonly reported barriers included poor integration of transitional care services, unmet patient or caregiver needs, underutilized services, and lack of physician buy-in.

CONCLUSION

True community partnership, high-quality communication, patient and family engagement, and ongoing evaluation and adaptation of transitional care strategies are ultimately needed to facilitate effective care transitions. Health care organizations can strategically prioritize transitional care service delivery through staffing decisions, by making transitional care part of the organization's formal board agenda, and by incentivizing excellence in providing transitional care services.

Gender-based Differential Item Functioning in the Application of the Theory of Planned Behavior for the Study of Entrepreneurial Intentions

Over the past years the percentage of female entrepreneurs has increased, yet it is still far below of that for males. Although various attempts have been made to explain differences in mens’ and women’s entrepreneurial attitudes and intentions, the extent to which those differences are due to self-report biases has not been yet considered. The present study utilized Differential Item Functioning (DIF) to compare men and women’s reporting on entrepreneurial intentions. DIF occurs in situations where members of different groups show differing probabilities of endorsing an item despite possessing the same level of the ability that the item is intended to measure. Drawing on the theory of planned behavior (TPB), the present study investigated whether constructs such as entrepreneurial attitudes, perceived behavioral control, subjective norms and intention would show gender differences and whether these gender differences could be explained by DIF. Using DIF methods on a dataset of 1800 Greek participants (50.4% female) indicated that differences at the item-level are almost non-existent. Moreover, the differential test functioning (DTF) analysis, which allows assessing the overall impact of DIF effects with all items being taken into account simultaneously, suggested that the effect of DIF across all the items for each scale was negligible. Future research should consider that measurement invariance can be assumed when using TPB constructs for the study of entrepreneurial motivation independent of gender.