Limits...
Does a pay-for-performance program for primary care physicians alleviate health inequity in childhood vaccination rates?

Katz A, Enns JE, Chateau D, Lix L, Jutte D, Edwards J, Brownell M, Metge C, Nickel N, Taylor C, Burland E, PATHS Equity Te - Int J Equity Health (2015)

Bottom Line: We compared these measures between study cohorts before and after implementation of the P4P program, and over the course of the P4P program in each cohort.The PIN cohort included 6,185 children.Inequality in income distribution was present at baseline and at study end in PIN and control cohorts.

View Article: PubMed Central - PubMed

Affiliation: Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. alan_katz@cpe.umanitoba.ca.

ABSTRACT

Introduction: Childhood vaccination rates in Manitoba populations with low socioeconomic status (SES) fall significantly below the provincial average. This study examined the impact of a pay-for-performance (P4P) program called the Physician Integrated Network (PIN) on health inequity in childhood vaccination rates.

Methods: The study used administrative data housed at the Manitoba Centre for Health Policy. We included all children born in Manitoba between 2003 and 2010 who were patients at PIN clinics receiving P4P funding matched with controls at non-participating clinics. We examined the rate of completion of the childhood primary vaccination series by age 2 across income quintiles (Q1-Q5). We estimated the distribution of income using the Gini coefficient, and calculated concentration indices for vaccination to determine whether the P4P program altered SES-related differences in vaccination completion. We compared these measures between study cohorts before and after implementation of the P4P program, and over the course of the P4P program in each cohort.

Results: The PIN cohort included 6,185 children. Rates of vaccination completion at baseline were between 0.53 (Q1) and 0.69 (Q5). Inequality in income distribution was present at baseline and at study end in PIN and control cohorts. SES-related inequity in vaccination completion worsened in non-PIN clinics (difference in concentration index 0.037; 95 % CI 0.013, 0.060), but remained constant in P4P-funded clinics (difference in concentration index 0.006; 95 % CI 0.008, 0.021).

Conclusions: The P4P program had a limited impact on vaccination rates and did not address health inequity.

Show MeSH
Flowchart depicting the creation of study cohorts from PATHS Data Resource administrative data
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4663722&req=5

Fig1: Flowchart depicting the creation of study cohorts from PATHS Data Resource administrative data

Mentions: The development of the study cohorts is described in Fig. 1. PIN clinics first identified their core patients in their electronic medical records using an established algorithm [33]. Children were included in the PIN clinic cohort if they were born in Manitoba between 2003 and 2010, were continuously registered with Manitoba Health, Healthy Living and Seniors (MHHLS) up to their second birthday, and were identified as core PIN clinic patients. We matched these patients to non-PIN clinic controls by RHA of residence, income quintile and birth year.Fig. 1


Does a pay-for-performance program for primary care physicians alleviate health inequity in childhood vaccination rates?

Katz A, Enns JE, Chateau D, Lix L, Jutte D, Edwards J, Brownell M, Metge C, Nickel N, Taylor C, Burland E, PATHS Equity Te - Int J Equity Health (2015)

Flowchart depicting the creation of study cohorts from PATHS Data Resource administrative data
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4663722&req=5

Fig1: Flowchart depicting the creation of study cohorts from PATHS Data Resource administrative data
Mentions: The development of the study cohorts is described in Fig. 1. PIN clinics first identified their core patients in their electronic medical records using an established algorithm [33]. Children were included in the PIN clinic cohort if they were born in Manitoba between 2003 and 2010, were continuously registered with Manitoba Health, Healthy Living and Seniors (MHHLS) up to their second birthday, and were identified as core PIN clinic patients. We matched these patients to non-PIN clinic controls by RHA of residence, income quintile and birth year.Fig. 1

Bottom Line: We compared these measures between study cohorts before and after implementation of the P4P program, and over the course of the P4P program in each cohort.The PIN cohort included 6,185 children.Inequality in income distribution was present at baseline and at study end in PIN and control cohorts.

View Article: PubMed Central - PubMed

Affiliation: Manitoba Centre for Health Policy, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada. alan_katz@cpe.umanitoba.ca.

ABSTRACT

Introduction: Childhood vaccination rates in Manitoba populations with low socioeconomic status (SES) fall significantly below the provincial average. This study examined the impact of a pay-for-performance (P4P) program called the Physician Integrated Network (PIN) on health inequity in childhood vaccination rates.

Methods: The study used administrative data housed at the Manitoba Centre for Health Policy. We included all children born in Manitoba between 2003 and 2010 who were patients at PIN clinics receiving P4P funding matched with controls at non-participating clinics. We examined the rate of completion of the childhood primary vaccination series by age 2 across income quintiles (Q1-Q5). We estimated the distribution of income using the Gini coefficient, and calculated concentration indices for vaccination to determine whether the P4P program altered SES-related differences in vaccination completion. We compared these measures between study cohorts before and after implementation of the P4P program, and over the course of the P4P program in each cohort.

Results: The PIN cohort included 6,185 children. Rates of vaccination completion at baseline were between 0.53 (Q1) and 0.69 (Q5). Inequality in income distribution was present at baseline and at study end in PIN and control cohorts. SES-related inequity in vaccination completion worsened in non-PIN clinics (difference in concentration index 0.037; 95 % CI 0.013, 0.060), but remained constant in P4P-funded clinics (difference in concentration index 0.006; 95 % CI 0.008, 0.021).

Conclusions: The P4P program had a limited impact on vaccination rates and did not address health inequity.

Show MeSH