英国における死亡率に対する初等医療における報酬効果の長期的証拠:人口研究
Andrew M Ryan1, Sam Krinsky1, Evangelos Kontopantelis2
1Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Lancet (London, England)
|May 22, 2016
まとめ
イギリスのQuality and Outcomes Framework (QOF) の業績報酬プログラムは,人口全体の死亡率を有意に低下させなかった. 特定の病気の領域における財政的インセンティブと死亡率の関係を評価するためにさらなる研究が必要である.
科学分野:
- 医療サービス研究
- 公衆衛生政策
- 研究成果
背景:
- イギリスは2004年に品質と成果の枠組み (Quality and Outcomes Framework, QOF) を導入し,世界最大のプライマリケア・ペア・フォー・パフォーマンス・プログラムを確立しました.
- この研究では,英国におけるQOFと人口の死亡率との関連を調査した.
研究 の 目的:
- QOFプログラムが人口死亡率の減少と関連しているかどうかを判断する.
- 公衆衛生上の成果に対する報酬制度の影響を評価する.
主な方法:
- 1994年から2010年までの英国と 比較可能な高所得国における 人口レベルの死亡率データを活用した.
- QOF標的の慢性疾患,心筋不全症,がん,および非標的の疾患に対する年齢調整および性別調整による死亡率を分析した.
- QOFの影響を評価するために,比較国から合成イギリスを作り出す.
主要な成果:
- QOFの導入は,標的の慢性疾患の複合的な結果における死亡率の変化と統計的に有意な関連性を示さなかった.
- 心臓発作,がん,非標的疾患の死亡率は,QOFの実施後の有意な変化を示さなかった.
- 10万人あたりの特定の死亡率の変化は,複合的なアウトカム (- 3. 68),不全性心疾患 (-2. 21),癌 (0. 28),非標的疾患 (11. 60) でした.
結論:
- QOFプログラムは,標的型疾患による死亡率のわずかな低下を観察したにもかかわらず,人口死亡率の有意な減少と関連付けられませんでした.
- この調査結果は,同様の報酬型プログラムが 住民の健康に与える影響について 慎重に考えるべきだと示唆しています.
- 特定の病気の領域における死亡率に対する財政的インセンティブの具体的な効果を理解するために,さらなる調査が推奨されます.
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