Long-Term Effects of Financial Incentives for General Practitioners on Quality Indicators in the Treatment of Patients With Diabetes Mellitus in Primary Care-A Follow-Up Analysis of a Cluster Randomized Parallel Controlled Trial.
Long-Term Effects of Financial Incentives for General Practitioners on Quality Indicators in the Treatment of Patients With Diabetes Mellitus in Primary Care-A Follow-Up Analysis of a Cluster Randomized Parallel Controlled Trial.
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DOI：
10.3389/fmed.2021.664510
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发表时间：
2021
影响因子：
3.9
通讯作者：
Rosemann T
中科院分区：
文献类型：
--
作者：
Meier R;Chmiel C;Valeri F;Muheim L;Senn O;Rosemann T
背景：财政奖励对初级保健质量的影响是人们高度关注的问题，在财政奖励取消后，其可持续性也是高度关注的。目的：根据来自电子病历的常规数据计算的质量指标(QI)，评估为全科医生(GP)治疗糖尿病患者提供财政激励的长期效果和可持续性。设计/参与者：随机对照试验，使用瑞士全科医生的糖尿病患者电子病历中的常规数据。干预：在为期24个月的研究期间，所有全科医生都会收到双月反馈报告，其中包含QI中反映的实际治疗信息。在干预组，报告与质量改进的经济激励相结合。这项激励措施在12个月后停止。测量：符合HbA1c年度测量过程QI和血压水平低于140/85毫米汞柱的临床QI的患者比例。结果：来自43个不同实践的71名全科医生以及3854名糖尿病患者被纳入研究。在整个研究过程中，干预组每年进行HbA1c检测的患者比例稳定(78.8-78.9%)，而对照组(81.5-80.2%)略有下降[优势比(OR)：1.21；95%CI：1.04-1.42，p<；0.05]。血压低于140/85毫米汞柱的患者比例在对照组下降(51.2-47.2%)，而在干预组(49.7-51.9%)上升(OR：1.18；95%CI：1.04-1.35，p<；0.05)，在18个月后达到峰值54.9%，并在过去6个月内稳步下降。结论：全科医生经济激励措施停用12个月后，部分QI仍有改善，提示1年时间可能太短，无法观察干预措施的全部效果。18个月后QI达标率的下降表明，有时间限制的财务激励的积极影响最终会减弱。
Background: The effect of financial incentives on the quality of primary care is of high interest, and so is its sustainability after financial incentives are withdrawn. Objective: To assess both long-term effects and sustainability of financial incentives for general practitioners (GPs) in the treatment of patients with diabetes mellitus based on quality indicators (QIs) calculated from routine data from electronic medical records. Design/Participants: Randomized controlled trial using routine data from electronic medical records of patients with diabetes mellitus of Swiss GPs. Intervention: During the study period of 24 months, all GPs received bimonthly feedback reports with information on their actual treatment as reflected in QIs. In the intervention group, the reports were combined with financial incentives for quality improvement. The incentive was stopped after 12 months. Measurements: Proportion of patients meeting the process QI of annual HbA1c measurements and the clinical QI of blood pressure levels below 140/85 mmHg. Results: A total of 71 GPs from 43 different practices were included along with 3,854 of their patients with diabetes mellitus. Throughout the study, the proportion of patients with annual HbA1c measurements was stable in the intervention group (78.8–78.9%) and decreased slightly in the control group (81.5–80.2%) [odds ratio (OR): 1.21; 95% CI: 1.04–1.42, p < 0.05]. The proportion of patients achieving blood pressure levels below 140/85 mmHg decreased in the control group (51.2–47.2%) and increased in the intervention group (49.7–51.9%) (OR: 1.18; 95% CI: 1.04–1.35, p < 0.05) where it peaked at 54.9% after 18 months and decreased steadily over the last 6 months. Conclusion: After the withdrawal of financial incentives for the GPs after 12 months, some QIs still improved, indicating that 1 year might be too short to observe the full effect of such interventions. The decrease in QI achievement rates after 18 months suggests that the positive effects of time-limited financial incentives eventually wane.
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影响因子：
2.9
作者：
Meier R;Muheim L;Senn O;Rosemann T;Chmiel C
通讯作者：
Chmiel C
DOI：
10.1136/bmj.d3590
发表时间：
2011-06-28
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Doran T;Kontopantelis E;Valderas JM;Campbell S;Roland M;Salisbury C;Reeves D
通讯作者：
Reeves D
影响因子：
39.2
作者：
Asch, SM;McGlynn, EA;Kerr, EA
通讯作者：
Kerr, EA
影响因子：
5.4
作者：
Lohmann, Julia;Houlfort, Nathalie;De Allegri, Manuela
通讯作者：
De Allegri, Manuela
影响因子：
2.8
作者：
Van Herck, Pieter;De Smedt, Delphine;Sermeus, Walter
通讯作者：
Sermeus, Walter