[영문]BaCKGROunD: Pay for performance (P4P) is a business model in which healthplans pay provider organizations (medical groups) financial incentives basedon attainment of clinical quality, patient experience, and use of informationtechnology. The California P4P program is the largest P4P program in theunited states and represents a potential revenue source for all participatingmedical groups. The clinical specifications for the California P4P program arebased on the national Committee for Quality assurance (nCQa), Health PlanEmployer Data, and information set (HEDis), and each clinical measure has itsown benchmark. in 2005, participating medical groups were paid on the basisof 9 clinical measures that were evaluated in the 2004 measurement year.The cholesterol testing measure represented 4.44%-7.14% of the total P4Pdollars available to participating medical groups from the health plans.OBjECTivEs: To (1) compare the percentage of medical group membersaged 18 to 75 years with diabetes (type 1 or type 2) who received a lowdensitylipoprotein cholesterol (lDl-C) test and attained lDl-C control(qqqlt;130 mg per dl) after enrolling in a chronic disease care management(CDCM) program with similar members managed by routine care, and to(2) assess the potential effect of CDCM on the quality performance rankingand financial reimbursement of a medical group reporting these measuresin the 2004 California P4P measurement year.METHODs: This is a retrospective database review of electronic laboratory(lab) values, medical and hospital claims, and encounter data collectedbetween january 1, 2003 and December 31, 2004 at 1 California medicalgroup comprising 160 multispecialty providers. Requirements werecontinuous patient enrollment in 1 of the 7 health plans participating in P4Pduring the measurement year (2004) with no more than 1 gap in enrollmentof up to 45 days. Patients aged 18 to 75 years were included in the diabetescholesterol measure (denominator) if they had at least 2 outpatientencounters coded for a primary, secondary, or tertiary diagnosis of diabetes(International Classification of Diseases, Ninth Revision, Clinical Modificationcode 250.xx, 357.2, 362.0, 366.41, 648.0) or 1 acute inpatient (DiagnosisRelated Group code 294 or 295) or emergency room visit for diabetes. labvalues were obtained from multiple sources, including archived lab databasesduring the same measurement period (numerator). The CDCM programprovided education and recommendations for diet, lifestyle, and medicationmodification delivered by a multidisciplinary team of nurses, pharmacists,and dieticians, and this intervention was compared with routine care forpatients not enrolled in the CDCM program.REsulTs: Of the 54,000 health plan members enrolled in this medical groupunder capitated reimbursement, 1,859 patients (3.4%) met the CaliforniaP4P specifications for eligibility for the diabetes cholesterol measures andwere evaluated. Of these, 8.9% (165/1,859) were followed by the CDCMprogram and 91.1% (1,694/1,859) by routine care. The lDl-C lab testing ratefor patients in the CDCM program was 91.5% (151/165), and the lDl-C goalrate was 78.2% (129/165) compared with 67.8% (1,148/1,694) and 55.7%,respectively, for routine care (P qqqlt; 0.001 for both comparisons). if the lDl-Clab testing and goal attainment rates for the CDCM group were comparedwith rates for peer medical groups, this medical group would have scoredin the 75th and 90th percentiles, respectively, corresponding to an annualrevenue potential of