How do performance-based financing programmes measure quality of care? A descriptive analysis of 68 quality checklists from 28 low- and middle-income countries
How do performance-based financing programmes measure quality of care? A descriptive analysis of 68 quality checklists from 28 low- and middle-income countries
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DOI：
10.1093/heapol/czx053
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发表时间：
2017-10-01
影响因子：
3.2
通讯作者：
Bauhoff, Sebastian
中科院分区：
文献类型：
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作者：
Josephson, Erik;Gergen, Jessica;Bauhoff, Sebastian
本文旨在系统地描述基于绩效的融资计划中使用的质量清单的长度和内容、它们的异同以及清单如何随着时间的推移而演变。我们根据文件审查编制了低收入和中低收入国家供应方、基于医疗机构的绩效融资 (PBF) 计划清单。然后，我们向这些 PBF 机制的实施者和捐助者征求了 PBF 手册和质量检查表。我们将每个质量检查表中的每个指标逐字输入英文数据库，并在适当的情况下从法语翻译成英语，并根据多纳贝迪框架和作者衍生的分类对每个指标进行分类。我们从 28 个国家/地区 32 个 PBF 实施的 68 个质量检查表中提取了 8,490 个质量指标。平均而言，清单包含 125 个指标；在同一个计划中，清单往往会随着更新而增加。使用Donabedian框架，80%的指标是结构型的，19%是过程型的，不到1%是结果型的。作者的分类显示，57% 的指标与资源可用性相关，24% 与设施管理相关，17% 与知识和努力相关。孕产妇、新生儿和儿童健康等常见服务类型清单中使用的一组狭窄指标具有高度相似性。我们的结论是，基于绩效的融资提供了一种有吸引力的方法，可以解决特定的质量缺陷并推进高质量覆盖的可持续发展目标。目前大多数指标侧重于结构性问题和资源可用性。这些项目的质量检查清单还有合理化和发展的空间，以帮助实现国家和全球提高护理质量的目标。
This paper seeks to systematically describe the length and content of quality checklists used in performance-based financing programmes, their similarities and differences, and how checklists have evolved over time. We compiled a list of supply-side, health facility-based performance-based financing (PBF) programmes in low- and lower middle-income countries based on a document review. We then solicited PBF manuals and quality checklists from implementers and donors of these PBF mechanisms. We entered each indicator from each quality checklist into a database verbatim in English, and translated into English from French where appropriate, and categorized each indicator according to the Donabedian framework and an author-derived categorization. We extracted 8,490 quality indicators from 68 quality checklists across 32 PBF implementations in 28 countries. On average, checklists contained 125 indicators; within the same program, checklists tend to grow as they are updated. Using the Donabedian framework, 80% of indicators were structure-type, 19% process-type, and less than 1% outcome-type. The author-derived categorization showed that 57% of indicators relate to availability of resources, 24% to managing the facility and 17% assess knowledge and effort. There is a high degree of similarity in a narrow set of indicators used in checklists for common service types such as maternal, neonatal and child health. We conclude that performance-based financing offers an appealing approach to targeting specific quality shortfalls and advancing toward the Sustainable Development Goals of high quality coverage. Currently most indicators focus on structural issues and resource availability. There is scope to rationalize and evolve the quality checklists of these programs to help achieve national and global goals to improve quality of care.