Reports of unintended consequences of financial incentives to improve management of hypertension
Reports of unintended consequences of financial incentives to improve management of hypertension
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DOI：
10.1371/journal.pone.0184856
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发表时间：
2017-09-21
期刊：
影响因子：
3.7
通讯作者：
Petersen, Laura A.
中科院分区：
文献类型：
--
作者：
Hysong, Sylvia J.;SoRelle, Richard;Petersen, Laura A.
鉴于全国范围内财政激励计划的增加，许多医生和医生团体担心提供财政激励以提高护理质量的潜在意外后果。然而，很少有研究探讨是否实际的意外后果的结果，提供财政奖励的医生。我们试图记录的程度，在文献中讨论的意外后果是观察到的随机临床试验（RCT）的财政incentivers.MethodsWe进行了定性观察研究嵌套在一个较大的RCT的财政激励措施，以提高高血压护理。我们进行了30分钟的电话采访，初级保健人员在设施参与随机对照试验设在12个地理分散的退伍军人事务部医疗中心全国。参与者回答了有关非预期效应、临床团队动态、组织对护理提供的影响、研究参与的问题。我们采用了一个混合的归纳和演绎定性技术analysis. ApplantsSixfive参与者被招募的RCT登记者和人员没有参加较大的RCT，加上一个初级保健领导人每个site.ResultsEmergent主题包括可能的病人伤害，强调文件，提高护理，降低专业士气，积极的溢出。所有关于涉及患者伤害的非预期后果的讨论都只是问题，而不是实际事件。一些意外后果涉及质量改进的辅助举措（例如，实践指南和业绩衡量系统），而不是财政激励措施。ConclusionsMany意想不到的后果，财政激励措施指出，要么只是关注或归因于辅助质量改进举措。实际的意外后果包括改善护理文件，但不一定改善实际护理，以及积极的意外后果。
BackgroundGiven the increase in financial-incentive programs nationwide, many physicians and physician groups are concerned about potential unintended consequences of providing financial incentives to improve quality of care. However, few studies examine whether actual unintended consequences result from providing financial incentives to physicians. We sought to document the extent to which the unintended consequences discussed in the literature were observable in a randomized clinical trial (RCT) of financial incentives.MethodsWe conducted a qualitative observational study nested within a larger RCT of financial incentives to improve hypertension care. We conducted 30-minute telephone interviews with primary care personnel at facilities participating in the RCT housed at12 geographically dispersed Veterans Affairs Medical Centers nationwide. Participants answered questions about unintended effects, clinic team dynamics, organizational impact on care delivery, study participation. We employed a blend of inductive and deductive qualitative techniques for analysis.ParticipantsSixty-five participants were recruited from RCT enrollees and personnel not enrolled in the larger RCT, plus one primary care leader per site.ResultsEmergent themes included possible patient harm, emphasis on documentation over improving care, reduced professional morale, and positive spillover. All discussions of unintended consequences involving patient harm were only concerns, not actual events. Several unintended consequences concerned ancillary initiatives for quality improvement (e.g., practice guidelines and performance measurement systems) rather than financial incentives.ConclusionsMany unintended consequences of financial incentives noted were either only concerns or attributable to ancillary quality-improvement initiatives. Actual unintended consequences included improved documentation of care without necessarily improving actual care, and positive unintended consequences.