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Paying for Prevention: Associations between Pay for Performance and Cessation Counseling in Primary Care Practices

Purpose. To examine associations between pay for performance (P4P) and recommended cessation counseling among primary care practices (PCPs). Design. Cross-sectional survey of 89 PCPs participating in a joint Robert Wood Johnson Foundation (RWJF)–Agency for Healthcare Research and Quality (AHRQ) health promotion initiative. Setting and Participants. 100% response rate from PCPs participating in the RWJF-AHRQ initiative. Measures. Survey data on cessation counseling, practice involvement with P4P, practice size, public reporting of performance, practice competition, linkages with community resources, integration of evidence-based guidelines, patient recommendations for cessation, and state-specific smoking rates. Analysis. Logistic regression was used to examine associations between practice involvement with P4P and cessation counseling offered by PCPs. Practice characteristics, including size and availability of other cessation services, were included in the analysis. Results. Practices that were involved with P4P had greater odds of offering recommended cessation counseling (odds ratio [OR] = 27.6, p < .01). Practices that linked patients to community resources, experienced greater competition, and were larger in size also provided more counseling (p < .05). Publicly reporting performance information and being located in states with higher smoking rates were associated with decreased odds of offering counseling support (p < .10). Conclusions. Findings suggest that P4P is associated with recommended counseling for smoking cessation. Study limitations include small sample size and unavailability of information on the magnitude of P4P incentives and program design. Further analysis considering these programmatic details is warranted.