支付绩效,护理质量和急性心肌梗塞的结果
Seth W Glickman1, Fang-Shu Ou, Elizabeth R DeLong
1Center for Clinical and Genetic Economics, Duke University Medical Center, Durham, NC, USA.
JAMA
|June 7, 2007
概括
在一项大型试点研究中,按绩效支付 (P4P) 计划并没有显著改善急性心肌梗塞治疗或结果. 该计划也没有对非激励性护理流程产生不利影响.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 质量改善倡议 质量改善倡议
- 心血管医学 心血管医学
背景情况:
- 按绩效支付 (P4P) 是一种提高医疗保健质量的策略.
- 医疗保险和医疗补助服务中心 (CMS) 在2003年启动了一项大型P4P试点项目,包括急性心肌梗塞 (AMI) 护理指标.
研究的目的:
- 评估P4P与AMI护理过程和结果的改善之间的关联.
- 确定P4P对非激励护理的潜在意外影响.
主要方法:
- 从2003年7月到2006年6月,对105,383名AMI患者进行了观察性,患者层面的分析.
- 在CRUSADE质量改进计划中,比较了54家参与P4P的医院和446家控制医院.
- 评估了对ACC/AHA指导疗法和住院死亡率的遵守.
主要成果:
- 在6种P4P激励疗法 (阿司匹林,戒烟) 中,在P4P医院的2种疗法 (阿司匹林,戒烟) 中略有改善 (P=.04,P=.05).
- 在P4P和对照组之间,激励或非激励治疗的复合措施没有显著差异.
- 在P4P地点没有观察到住院死亡率的增量改善 (P=.21).
结论:
- CMS P4P计划与AMI护理质量或结果的显著增量改善无关.
- 没有发现P4P与非激励护理过程的改善之间存在不良关联.
- 需要进一步的研究来确定P4P在质量改进中的最佳作用.
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