Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil.
Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil.
复制标题
在初级医疗保健水平上提供母亲和育儿：PMAQ作为巴西绩效策略的作用。
DOI：
10.1371/journal.pone.0240631
复制
发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
da Silva EN
中科院分区：
文献类型：
--
作者：
de Medeiros OL;Barreto JOM;Harris M;Russo LX;da Silva EN
改善卫生保健的可及性和质量是全世界的一个紧迫问题，绩效付费战略已成为加强卫生保健结构、进程和成果的一种替代办法。2011年，巴西在国家一级通过了第一个P4P计划，即《改善初级保健服务和质量国家方案》。巴西仍在调查PMAQ在实现与孕产妇和儿童保育有关的可持续发展目标方面的贡献。评估PMAQ与巴西提供孕产妇和儿童保育的关系，控制社会经济、地理和家庭保健团队特征。我们使用了两个时期的横截面分位数回归（QR）模型，对应于PMAQ第一周期的33，368个家庭健康团队（FHT）和第二周期的39，211个FHT。使用巴西卫生部（SIAB和CNES）和巴西地理和统计研究所（IBGE）的数据分析了FHT。每月产前咨询的平均数量与PMAQ参与团队呈正相关，在响应变量的条件分布的下尾（第10和第25分位数）具有较大的影响。PMAQ与2岁以下儿童每月平均就诊次数在第10和25分位数呈正相关，但在上尾（第75和90分位数）呈负相关。对于1岁以下儿童每月的平均医生咨询次数，PMAQ参与团队与下尾的响应变量呈正相关，但与以往模型不同的是，没有明确的证据表明第二周期与第一周期相比给出了更大的系数。该方案为在初级保健一级增加向孕妇和2岁以下儿童提供的护理做出了贡献。产前或儿童咨询平均次数较低的团队通过参与PMAQ受益最多，这表明PMAQ可能会激励表现较差的医疗服务提供者迎头赶上。
Improving access and quality in health care is a pressing issue worldwide and pay for performance (P4P) strategies have emerged as an alternative to enhance structure, process and outcomes in health. In 2011, Brazil adopted its first P4P scheme at national level, the National Programme for Improving Primary Care Access and Quality (PMAQ). The contribution of PMAQ in achieving the Sustainable Development Goals related to maternal and childcare remains under investigated in Brazil. To estimate the association of PMAQ with the provision of maternal and childcare in Brazil, controlling for socioeconomic, geographic and family health team characteristics. We used cross-sectional quantile regression (QR) models for two periods, corresponding to 33,368 Family Health Teams (FHTs) in the first cycle and 39,211 FHTs in the second cycle of PMAQ. FHTs were analysed using data from the Brazilian Ministry of Health (SIAB and CNES) and the Brazilian Institute for Geography and Statistics (IBGE). The average number of antenatal consultations per month were positively associated with PMAQ participating teams, with larger effect in the lower tail (10th and 25th quantiles) of the conditional distribution of the response variable. There was a positive association between PMAQ and the average number of consultations under 2 years old per month in the 10th and 25th quantiles, but a negative association in the upper tail (75th and 90th quantiles). For the average number of physician consultations for children under 1 year old per month, PMAQ participating teams were positively associated with the response variable in the lower tail, but different from the previous models, there is no clear evidence that the second cycle gives larger coefficients compared with first cycle. PMAQ has contributed to increase the provision of care to pregnant women and children under 2 years at primary healthcare level. Teams with lower average number of antenatal or child consultations benefited the most by participating in PMAQ, which suggests that PMAQ might motivate worse performing health providers to catch up.
登录
查看更多内容
影响因子：
3.7
作者：
Héquet D;Kralidis G;Carrel T;Cusini A;Garzoni C;Hullin R;Meylan PR;Mohacsi P;Mueller NJ;Ruschitzka F;Tozzi P;van Delden C;Weisser M;Wilhelm MJ;Pascual M;Manuel O;Swiss Transplant Cohort Study (STCS)
通讯作者：
Swiss Transplant Cohort Study (STCS)
影响因子：
8.1
作者：
da Silva EN;Powell-Jackson T
通讯作者：
Powell-Jackson T
DOI：
10.11606/s1518-8787.2018052000395
发表时间：
2018-01-01
期刊：
Revista de Saúde Pública
影响因子：
--
作者：
Alonso, Carolina Maria do Carmo;Béguin, Pascal Daniel;Duarte, Francisco José de Castro Moura
通讯作者：
Duarte, Francisco José de Castro Moura
DOI：
10.11606/s1518-8787.2018052000186
发表时间：
2018-01-01
期刊：
Revista de Saúde Pública
影响因子：
--
作者：
Santos, Andréia Soprani dos;Duro, Suele Manjourany Silva;Tomasi, Elaine
通讯作者：
Tomasi, Elaine
影响因子：
3.2
作者：
Josephson, Erik;Gergen, Jessica;Bauhoff, Sebastian
通讯作者：
Bauhoff, Sebastian