Application of the analytic hierarchy process in the performance measurement of colorectal cancer care for the design of a pay-for-performance program in Taiwan

OBJECTIVE: To prioritize performance measures for colorectal cancer care to facilitate the implementation of a pay-for-performance (PFP) system. DESIGN: Questionnaires survey. SETTING: Medical hospitals in Taiwan. PARTICIPANTS: Sixty-six medical doctors from 5 November 2009 to 10 December 2009. INTERVENTION: Analytic hierarchy process (AHP) technique. Main outcome measure(s) Performance measures (two pre-treatment, six treatment related and three monitoring related) were used. RESULTS: Forty-eight doctors responded and returned questionnaires (response rate 72.7%) with surgeons and physicians contributing equally. The most important measure was the proportion of colorectal patients who had pre-operative examinations that included chest X-ray and abdominal ultrasound, computed tomography or MRI (global priority: 0.144), followed by the proportion of stages I-III colorectal cancer patients who had undergone a wide surgical resection documented as 'negative margin' (global priority: 0.133) and the proportion of colorectal cancer patients who had undergone surgery with a pathology report that included information on tumor size and node differentiation (global priority: 0.116). Most participants considered that the best interval for the renewal indicators was 3-5 years (43.75%) followed by 5-10 years (27.08%). CONCLUSIONS: To design a PFP program, the AHP method is a useful technique to prioritize performance measures, especially in a highly specialized domain such as colorectal cancer care.