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Process measures are more directly under the control of providers than outcomes.
The panel discussed the validity of each of the proposed measures and retained those with adequate evidence of the good practice measured and achievable or with the indicator compliance under control of providers.
The P4P scheme may provide the incentive and means to address certain constraints, in so far as they are within the control of providers and managers, however, other constraints will be harder to address.
Case-mix adjustment seeks to control for differences in patient characteristics not under the control of providers to facilitate fair comparison among healthcare providers by estimating the scores providers would have received if serving a common population. 1 Such adjustment can be applied to measures of clinical process, 2 3 patient experience, 1 4–7 and medical outcomes.
The implementation of the P4P scheme in Pwani region in Tanzania may provide the incentive and means to address certain constraints, in so far as they are within the control of providers and managers, however, other constraints will be harder to address.
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In fact, initial results suggest that chronic care management, preventive care for adults and pediatric care have all improved compared with a control group of providers, almost all of which were paid on a fee-for-service basis by Blue Cross.
The first control group of providers not exposed to the programme consists of a sample of 148 providers drawn from 58 facilities in 17 districts in the same three regions as the treatment group (Ashanti, Eastern and Greater Accra).
During an ICU stay, one patient may be cared for by many providers, and if different triggers, therapeutic means, and targets for glycemic control of different providers are applied to a particular patient, any potential clinical benefit of glycemic control many be negated.
However, to compare the performances of care providers a case mix correction is needed, because client populations may differ on characteristics beyond the control of care providers.
The Brazilian investment firm Opportunity, now Brasil Telecom's biggest shareholder, filed an arbitration complaint against Telecom Italia with the International Chamber of Commerce late last year, arguing that Brazilian regulations prohibit a company from having control of two providers of the same phone service in the same region.
Although apparently under the control of the providers, the utilization of health care services had generally small ICCs.
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