医生支付模式和预防性癌症查:来自加拿大安大略省的基于人口的回顾性队列分析
Yihong Bai1,2,3, Rose Anne Devlin4, Steven Habbous1,5
1Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada N6G 2M1.
Family practice
|October 22, 2025
概括
与安大略省的服务费相比,混合资本化模型,特别是与团队一起,改善了癌症查率. 这些收益在整个流行病期间持续存在,特别是在农村和服务不足的地区.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 主要护理政策 基本护理政策
- 预防医学 预防医学
背景情况:
- 安大略省推出了三种医生支付模式:混合费用服务 (BFFS),没有团队的混合资本,以及与团队的混合资本.
- 所有模型都分享了按绩效支付的激励措施,但它们对癌症查的比较有效性,包括在COVID-19大流行期间,是未知的.
研究的目的:
- 评估不同初级保健支付模式对安大略省癌症查率的影响.
- 为了比较混合资本化模型与混合费用服务模型在促进结直肠,宫和乳腺癌查方面的有效性.
主要方法:
- 利用了2018-2023年间的相关行政数据.
- 采用分数探针回归模型来评估支付模式和查率之间的关联,并根据医生和患者因素进行调整.
- 根据医生和实践特征进行了分层分析,以探索异质性.
主要成果:
- 与BFFS模型相比,混合封顶模型与更高的癌症查率有关.
- 到2022年,结直肠癌查率在非团队和团队队长模型中分别高出3.0%和3.6%.
- 宫癌和乳腺癌的查率有所改善,在COVID-19期间持续,在农村和社会经济贫困地区最为显著. 女性,年轻和体积较大的医生在顶部模型中表现更好.
结论:
- 混合资本,特别是与跨专业团队,在提供预防性癌症查方面比BFFS更有效.
- 加强以团队为基础的初级保健和有针对性的激励措施可以提高查率,即使在面临大流行挑战.
- 调查结果支持政策决策,以优化初级保健,以改善人口健康结果.
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