英国质量和成果框架绩效支付计划对初级保健质量的影响:系统性审查与定量综合
Leonard Ho1, Stewart W Mercer2, David Henderson3
1NIHR Health Determinants Research Collaboration Aberdeen, Aberdeen, UK.
BMJ (Clinical research ed.)
|June 25, 2025
概括
英国质量和成果框架中的财政激励措施在一年内改善了护理质量,但在三年内不一致. 取消激励措施扭转了这些收益,往往超过了最初的改善.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗保健政策 医疗保健政策
- 提高质量 提高质量
背景情况:
- 英国的质量和成果框架 (QOF) 引入了财政激励措施,以提高初级保健质量.
- 这些绩效支付激励措施对护理质量的影响需要随着时间的推移进行系统评估.
研究的目的:
- 系统地审查在QOF内引入和撤销金融激励措施对护理质量的影响.
- 评估这些财政激励措施对医疗保健质量的一年和三年的影响.
主要方法:
- 一个系统的审查,包括从符合条件的研究数据的定量综合.
- 在2004年1月至2024年9月期间搜索了多个数据库 (MEDLINE,Embase,CINAHL,PsycINFO,Scopus).
- 使用中断时间序列分析进行定量合成,用混合方法评估工具评估偏差风险.
主要成果:
- 引入激励措施在一年后改善了记录质量 (中位变化6.1个百分点),但在三年后不一致 (中位变化0.7个百分点).
- 在一年 (中位变化-10.7个百分点) 和三年 (中位变化-12.8个百分点) 后,激励退出降低了记录质量.
- 影响因指标类型而异,复杂的过程 (如糖尿病脚查) 显示出比简单的过程或结果更大的变化.
结论:
- QOF金融激励措施在一年后改善了护理质量,但这一效应在三年后减弱并变得不一致.
- 取消激励措施导致质量下降,往往抵消或超过激励期间取得的收益.
- 调查结果表明,持续的质量改进需要持续的战略,而不仅仅是临时的金融激励措施.
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