Does increased provider effort improve quality of care? Evidence from a standardised patient study on correct and unnecessary treatment.
Does increased provider effort improve quality of care? Evidence from a standardised patient study on correct and unnecessary treatment.
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DOI：
10.1186/s12913-023-09149-5
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发表时间：
2023-02-23
影响因子：
2.8
通讯作者：
中科院分区：
文献类型：
--
作者：
护理质量差，包括过度提供（不必要的护理）是一个全球性的健康问题。更大的供应商的努力已被证明可以增加正确治疗的可能性，但其与过度供应的关系不太清楚。提供者谁作出更多的努力可能会给更多的治疗整体，正确的和不必要的，或者可能有较低的比率过度提供;我们测试这是真实的坦桑尼亚私营卫生部门。标准化的患者访问了坦桑尼亚的227家私营营利和信仰机构，表现出哮喘和结核病症状。他们记录了询问的历史问题和提供者进行的体检，以及下令进行的实验室检查，规定的治疗和支付的费用。提供者努力的措施是建立在推荐的历史采取的问题和体检清单的基础上。15%的SP接受了正确的护理，74%的SP接受了不必要的护理。提供者努力的增加与正确护理的可能性增加有关，并降低了提供不必要护理的可能性。付出更多努力的提供者通过更高的咨询费机制收取更高的费用，而不是增加实验室测试和药物的费用。付出更多努力的提供者更有可能正确对待患者。这项研究的一个新发现是，他们也不太可能提供不必要的护理，这表明这不仅仅是一些提供者做“更多的一切”的情况，而是那些在咨询中做得更多的人提供了更有针对性的护理。在线版本包含补充材料，可通过10.1186/s12913-023-09149-5获得。
Poor quality of care, including overprovision (unnecessary care) is a global health concern. Greater provider effort has been shown to increase the likelihood of correct treatment, but its relationship with overprovision is less clear. Providers who make more effort may give more treatment overall, both correct and unnecessary, or may have lower rates of overprovision; we test which is true in the Tanzanian private health sector. Standardised patients visited 227 private-for-profit and faith-based facilities in Tanzania, presenting with symptoms of asthma and TB. They recorded history questions asked and physical examinations carried out by the provider, as well as laboratory tests ordered, treatments prescribed, and fees paid. A measure of provider effort was constructed on the basis of a checklist of recommended history taking questions and physical exams. 15% of SPs received the correct care for their condition and 74% received unnecessary care. Increased provider effort was associated with increased likelihood of correct care, and decreased likelihood of giving unnecessary care. Providers who made more effort charged higher fees, through the mechanism of higher consultation fees, rather than increased fees for lab tests and drugs. Providers who made more effort were more likely to treat patients correctly. A novel finding of this study is that they were also less likely to provide unnecessary care, suggesting it is not simply a case of some providers doing “more of everything”, but that those who do more in the consultation give more targeted care. The online version contains supplementary material available at 10.1186/s12913-023-09149-5.
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影响因子：
8.1
作者：
Daniels B;Dolinger A;Bedoya G;Rogo K;Goicoechea A;Coarasa J;Wafula F;Mwaura N;Kimeu R;Das J
通讯作者：
Das J
影响因子：
39
作者：
Morgan DJ;Dhruva SS;Coon ER;Wright SM;Korenstein D
通讯作者：
Korenstein D
影响因子：
5
作者：
Leonard, Kenneth L.;Masatu, Melkiory C.
通讯作者：
Masatu, Melkiory C.
影响因子：
10.7
作者：
Das, Jishnu;Holla, Alaka;Muralidharan, Karthik
通讯作者：
Muralidharan, Karthik
DOI：
10.1016/s2214-109x(18)30386-3
发表时间：
2018-11
期刊：
The Lancet. Global health
影响因子：
--
作者：
Kruk ME;Gage AD;Arsenault C;Jordan K;Leslie HH;Roder-DeWan S;Adeyi O;Barker P;Daelmans B;Doubova SV;English M;García-Elorrio E;Guanais F;Gureje O;Hirschhorn LR;Jiang L;Kelley E;Lemango ET;Liljestrand J;Malata A;Marchant T;Matsoso MP;Meara JG;Mohanan M;Ndiaye Y;Norheim OF;Reddy KS;Rowe AK;Salomon JA;Thapa G;Twum-Danso NAY;Pate M
通讯作者：
Pate M