Financial team incentives improved recording of diagnoses in primary care: a quasi-experimental longitudinal follow-up study with controls.
Financial team incentives improved recording of diagnoses in primary care: a quasi-experimental longitudinal follow-up study with controls.
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DOI：
10.1186/s13104-015-1602-1
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发表时间：
2015-11-11
影响因子：
1.8
通讯作者：
Heikkinen, Anna Maria
中科院分区：
文献类型：
--
作者：
Lehtovuori, Tuomo;Kauppila, Timo;Heikkinen, Anna Maria
背景技术背景：在初级保健中，经济激励通常针对医生，因为他们被认为是改变医疗机构职能的关键决策者。尽管初级保健就诊记录诊断的频率很低，但没有研究表明将这些激励措施用于护理团队的所有学科（例如护士和医生的集体奖金）可能会产生什么影响。本研究测试的效果提供组奖金的care teams.METHODS：这是一个回顾性的准实验研究，前后设置和两个对照组。在干预组中，每个单独的护理团队记录诊断的医生就诊的平均百分比（记录诊断的医生每月就诊的平均团队百分比），同时从两个不同的初级保健环境中收集相同的数据，其中没有团队奖金。为了研究使用团体奖金获得的变化的可持续性，在干预停止后2年，从电子健康记录系统中获得相应的数据。标记诊断率的差异用ANOVA和RM-ANOVA进行分析，并进行适当的事后检验，标记诊断的变化率的差异用线性回归进行分析，然后进行t检验。结果：在开始使用组奖金之前，在团队中记录诊断的医生访问的比例约为55%，在此干预后为90%。控制单位没有增加。干预的效果略有减弱后停止组bonus.CONCLUSION：组奖金可能提供一种方法来改变初级保健的临床实践。然而，在停止这类财政激励措施后，这些干预措施的可持续性可能会减弱。
BACKGROUND: In primary care, financial incentives have usually been directed to physicians because they are thought to make the key decisions in order to change the functions of a medical organization. There are no studies regarding the impact that directing these incentives to all disciplines of the care team (e.g. group bonuses for both nurses and doctors) may have, despite the low frequency with which diagnoses were being recorded for primary care visits to doctors. This study tested the effect of offering group bonuses to the care teams.METHODS: This was a retrospective quasi-experimental study with before-and-after settings and two control groups. In the intervention group, the mean percentage of visits to a doctor for which a diagnosis was recorded by each individual care team (mean team-based percentage of monthly visits to a doctor with recorded diagnoses) and simultaneously the same data was gathered from two different primary care settings where no team bonuses were applied. To study the sustainability of changes obtained with the group bonuses the respective data were derived from the electronic health record system for 2 years after the cessation of the intervention. The differences in the rate of marking diagnoses was analyzed with ANOVA and RM-ANOVA with appropriate post hoc tests, and the differences in the rate of change in marking diagnoses was analyzed with linear regression followed by t-test.RESULTS: The proportion of doctor visits having recorded diagnoses in the teams was about 55 % before starting to use group bonuses and 90 % after this intervention. There was no such increase in control units. The effect of the intervention weakened slightly after cessation of the group bonuses.CONCLUSION: Group bonuses may provide a method to alter clinical practices in primary care. However, sustainability of these interventions may diminish after ceasing this type of financial incentive.