Estimated impact from the withdrawal of primary care financial incentives on selected indicators of quality of care in Scotland: controlled interrupted time series analysis.
Estimated impact from the withdrawal of primary care financial incentives on selected indicators of quality of care in Scotland: controlled interrupted time series analysis.
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DOI：
10.1136/bmj-2022-072098
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发表时间：
2023-03-22
影响因子：
105.7
通讯作者：
Guthrie, Bruce
中科院分区：
文献类型：
--
作者：
Morales, Daniel R.;Minchin, Mark;Kontopantelis, Evangelos;Roland, Martin;Sutton, Matt;Guthrie, Bruce
确定2016年苏格兰初级保健质量和成果框架（QOF）计划的撤回是否对选定的记录护理质量产生影响，并与该计划仍在继续的英格兰进行比较。受控中断时间序列回归分析。苏格兰和英格兰的一般做法。2013-14年，苏格兰有979个诊所，注册患者5599171人，英格兰有7921个诊所，注册患者56270628人，2018-19年，苏格兰减少到864个诊所，英格兰减少到6873个，主要是由于诊所合并。2015-16财政年度结束时，苏格兰QOF财政激励措施撤销后一年和三年的护理质量变化，每年测量16项指标（两个复杂过程，九个中间结果和五个治疗），从2013-14财政年度到2018-19财政年度。与英格兰相比，在QOF被废除一年后，苏格兰16项护理质量指标中有12项的绩效显著下降，在QOF被废除三年后，16项指标中有10项的绩效显著下降。三年后，苏格兰和英格兰之间的绝对百分点差异最大的记录（通过勾选框）是精神卫生保健计划（-40.2个百分点，95%置信区间-45.5到-35.0）和糖尿病足筛查（-22.8，-33.9到-11.7）。然而，在中间结果中也观察到了显著的降低，包括外周动脉疾病患者的血压控制（−18.5，−22.1至−14.9），中风或短暂性脑缺血发作（−16.6，−20.6至−12.7），高血压（−13.7，−19.4至−7.9），糖尿病（-12.7，-15.0至-12.4），或冠心病（−12.8，−14.9至−10.8），以及HbA 1c水平≤75 mmol/mol（−5.0，−8.4至−1.5）的糖化血红蛋白控制。在取消激励措施三年后，苏格兰和英格兰之间在流感免疫和抗血小板或抗凝治疗冠心病方面没有观察到显著差异。苏格兰取消财政激励措施与大多数绩效指标记录的护理质量下降有关。应仔细设计和实施按业绩支付的改革，以监测和应对护理质量的任何下降。
To determine whether the withdrawal of the Quality and Outcomes Framework (QOF) scheme in primary care in Scotland in 2016 had an impact on selected recorded quality of care, compared with England where the scheme continued. Controlled interrupted time series regression analysis. General practices in Scotland and England. 979 practices with 5 599 171 registered patients in Scotland, and 7921 practices with 56 270 628 registered patients in England in 2013-14, decreasing to 864 practices in Scotland and 6873 in England in 2018-19, mainly due to practice mergers. Changes in quality of care at one year and three years after withdrawal of QOF financial incentives in Scotland at the end of the 2015-16 financial year for 16 indicators (two complex processes, nine intermediate outcomes, and five treatments) measured annually for financial years from 2013-14 to 2018-19. A significant decrease in performance was observed for 12 of the 16 quality of care indicators in Scotland one year after QOF was abolished and for 10 of the 16 indicators three years after QOF was abolished, compared with England. At three years, the absolute percentage point difference between Scotland and England was largest for recording (by tick box) of mental health care planning (−40.2 percentage points, 95% confidence interval −45.5 to −35.0) and diabetic foot screening (−22.8, −33.9 to −11.7). Substantial reductions were, however, also observed for intermediate outcomes, including blood pressure control in patients with peripheral arterial disease (−18.5, −22.1 to −14.9), stroke or transient ischaemic attack (−16.6, −20.6 to −12.7), hypertension (−13.7, −19.4 to −7.9), diabetes (−12.7, −15.0 to −12.4), or coronary heart disease (−12.8, −14.9 to −10.8), and for glycated haemoglobin control in people with HbA1c levels ≤75 mmol/mol (−5.0, −8.4 to −1.5). No significant differences were observed between Scotland and England for influenza immunisation and antiplatelet or anticoagulant treatment for coronary heart disease three years after withdrawal of incentives. The abolition of financial incentives in Scotland was associated with reductions in recorded quality of care for most performance indicators. Changes to pay for performance should be carefully designed and implemented to monitor and respond to any reductions in care quality.
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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：
3.9
作者：
Meier R;Chmiel C;Valeri F;Muheim L;Senn O;Rosemann T
通讯作者：
Rosemann T
影响因子：
1.8
作者：
Lehtovuori, Tuomo;Kauppila, Timo;Heikkinen, Anna Maria
通讯作者：
Heikkinen, Anna Maria
影响因子：
158.5
作者：
Dreischulte, Tobias;Donnan, Peter;Guthrie, Bruce
通讯作者：
Guthrie, Bruce
影响因子：
3.7
作者：
Hysong, Sylvia J.;SoRelle, Richard;Petersen, Laura A.
通讯作者：
Petersen, Laura A.