The impact of performance incentives on child health outcomes: results from a cluster randomized controlled trial in the Philippines
The impact of performance incentives on child health outcomes: results from a cluster randomized controlled trial in the Philippines
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DOI：
10.1093/heapol/czt047
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发表时间：
2014-08-01
影响因子：
3.2
通讯作者：
McCulloch, Charles
中科院分区：
文献类型：
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作者：
Peabody, John W.;Shimkhada, Riti;McCulloch, Charles
使用测量和支付激励措施来改善临床表现，包括按绩效付费(或P4P)，到目前为止，对患者结果的好处不大，甚至没有任何好处。我们的目标是评估P4P计划对菲律宾儿科健康结果的影响。我们使用了质量改进示范研究的数据。在这项研究中，2004年引入的P4P干预被随机分配到10家社区地区医院，这些医院与10个控制点相匹配。在所有地点，在36个月的时间里，每6个月随机选择一名医生，使用临床表现片段(CPV)来衡量医生的质量。在随机接受P4P干预的医院中，如果医生在CPV上达到合格分数，他们就会收到奖金。我们测量了5岁及以下儿童出院后4-10周的健康结果，这些儿童因腹泻和肺炎(影响这一年龄段的两种最常见的疾病)而住院，并一直在参与研究的医生的护理下。在基线/干预前和干预后两年收集以下出院后结果的健康结果数据：(1)年龄调整后的消瘦，(2)血液中的C-反应蛋白，(3)血红蛋白水平和(4)父母使用一般自我报告健康(GSRH)测量对儿童健康的评估。为了评估控制点和干预点的健康结果随时间的变化(基线和干预后)，我们使用了差异差异Logistic回归分析，控制了潜在的混杂因素。我们发现，与对照地点相比，干预地点的GSRH改善了7个百分点和9个百分点，并随着时间的推移(干预后与基线相比)消退(P
Improving clinical performance using measurement and payment incentives, including pay for performance (or P4P), has, so far, shown modest to no benefit on patient outcomes. Our objective was to assess the impact of a P4P programme on paediatric health outcomes in the Philippines. We used data from the Quality Improvement Demonstration Study. In this study, the P4P intervention, introduced in 2004, was randomly assigned to 10 community district hospitals, which were matched to 10 control sites. At all sites, physician quality was measured using Clinical Performance Vignettes (CPVs) among randomly selected physicians every 6 months over a 36-month period. In the hospitals randomized to the P4P intervention, physicians received bonus payments if they met qualifying scores on the CPV. We measured health outcomes 4-10 weeks after hospital discharge among children 5 years of age and under who had been hospitalized for diarrhoea and pneumonia (the two most common illnesses affecting this age cohort) and had been under the care of physicians participating in the study. Health outcomes data collection was done at baseline/pre-intervention and 2 years post-intervention on the following post-discharge outcomes: (1) age-adjusted wasting, (2) C-reactive protein in blood, (3) haemoglobin level and (4) parental assessment of child's health using general self-reported health (GSRH) measure. To evaluate changes in health outcomes in the control vs intervention sites over time (baseline vs post-intervention), we used a difference-in-difference logistic regression analysis, controlling for potential confounders. We found an improvement of 7 and 9 percentage points in GSRH and wasting over time (post-intervention vs baseline) in the intervention sites relative to the control sites (P