Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009-2018.
Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009-2018.
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DOI：
10.1136/bmjgh-2021-005429
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发表时间：
2021-07
影响因子：
8.1
通讯作者：
Silva EN
中科院分区：
文献类型：
--
作者：
Russo LX;Powell-Jackson T;Maia Barreto JO;Borghi J;Kovacs R;Gurgel Junior GD;Gomes LB;Sampaio J;Shimizu HE;de Sousa ANA;Bezerra AFB;Stein AT;Silva EN
在低收入和中等收入国家，按业绩计薪计划对供应商业绩的影响有好有坏。巴西于2011年推出了第一个国家一级的P4P计划（PMAQ-巴西改善初级保健服务和质量国家方案）。PMAQ可能是世界上最大的P4P计划之一。我们基于一个由5564个城市组成的小组，估计了PMAQ与因门诊护理敏感性疾病（ACSC）住院之间的关联。我们在2009-2018年期间进行了固定效应面板数据分析，控制了初级医疗保健覆盖率，每万人口医院床位，教育，人均真实的国内生产总值和人口密度。结果是每10，000人中64岁及以下人群中ACSC的住院率。我们的暴露变量被定义为参与PMAQ的家庭健康团队的百分比，它反映了PMAQ随着时间的推移而推出的情况。我们还提供了几项敏感性分析，通过使用暴露和结局变量的替代措施，以及使用交通事故住院而不是ACSC的安慰剂试验。结果显示，所有年龄组的PMAQ和ACSC率之间存在负相关和统计学显著相关。PMAQ参与率每增加一个百分点，ACSC的住院率就会降低0.0356（SE 0.0123，p=0.004）/10000人群（0-64岁）。这相当于2018年减少了约60，829例住院治疗。对5岁以下儿童的影响更大（-0.0940，SE 0.0375，p=0.012），意味着减少了约11936例住院。我们的安慰剂试验表明，PMAQ与交通事故住院率的相关性不具有统计学意义，正如预期的那样。我们发现PMAQ与ACSC住院率的适度降低相关。
Evidence on the effect of pay-for-performance (P4P) schemes on provider performance is mixed in low-income and middle-income countries. Brazil introduced its first national-level P4P scheme in 2011 (PMAQ-Brazilian National Programme for Improving Primary Care Access and Quality). PMAQ is likely one of the largest P4P schemes in the world. We estimate the association between PMAQ and hospitalisations for ambulatory care sensitive conditions (ACSCs) based on a panel of 5564 municipalities. We conducted a fixed effect panel data analysis over the period of 2009–2018, controlling for coverage of primary healthcare, hospital beds per 10 000 population, education, real gross domestic product per capita and population density. The outcome is the hospitalisation rate for ACSCs among people aged 64 years and under per 10 000 population. Our exposure variable is defined as the percentage of family health teams participating in PMAQ, which captures the roll-out of PMAQ over time. We also provided several sensitivity analyses, by using alternative measures of the exposure and outcome variables, and a placebo test using transport accident hospitalisations instead of ACSCs. The results show a negative and statistically significant association between the rollout of PMAQ and ACSC rates for all age groups. An increase in PMAQ participating of one percentage point decreased the hospitalisation rate for ACSC by 0.0356 (SE 0.0123, p=0.004) per 10 000 population (aged 0–64 years). This corresponds to a reduction of approximately 60 829 hospitalisations in 2018. The impact is stronger for children under 5 years (−0.0940, SE 0.0375, p=0.012), representing a reduction of around 11 936 hospitalisations. Our placebo test shows that the association of PMAQ on the hospitalisation rate for transport accidents is not statistically significant, as expected. We find that PMAQ was associated with a modest reduction in hospitalisation for ACSCs.
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DOI：
10.1016/s2214-109x(20)30480-0
发表时间：
2021-03
期刊：
The Lancet. Global health
影响因子：
--
作者：
Kovacs R;Maia Barreto JO;da Silva EN;Borghi J;Kristensen SR;Costa DRT;Bezerra Gomes L;Gurgel GD Junior;Sampaio J;Powell-Jackson T
通讯作者：
Powell-Jackson T
影响因子：
2.8
作者：
Hone, Thomas;Powell-Jackson, Timothy;Millett, Christopher
通讯作者：
Millett, Christopher
DOI：
10.1590/0103-1104201811705
发表时间：
2018-06-01
期刊：
Saúde em Debate
影响因子：
--
作者：
Bertusso, Francielle Regina;Rizzotto, Maria Lucia Frizon
通讯作者：
Rizzotto, Maria Lucia Frizon
影响因子：
0.5
作者：
de Oliveira, Felipe Proenco;Vanni, Tazio;Cyrino, Eliana Goldfarb
通讯作者：
Cyrino, Eliana Goldfarb
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。
影响因子：
3.7
作者：
de Medeiros OL;Barreto JOM;Harris M;Russo LX;da Silva EN
通讯作者：
da Silva EN