Unintended Consequences of Implementing a National Performance Measurement System into Local Practice
Unintended Consequences of Implementing a National Performance Measurement System into Local Practice
复制标题
在地方实践中实施国家绩效衡量体系的意外后果
DOI：
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发表时间：
2012
影响因子：
5.7
通讯作者：
H. Bloomfield
中科院分区：
文献类型：
--
作者：
A. Powell;Katie M. White;M. Partin;Krysten Halek;J. Christianson;Brian Neil;S. Hysong;E. Zarling;H. Bloomfield
摘要背景 尽管绩效衡量 (PM) 系统的好处已得到充分证明，但对初级保健中绩效衡量系统的负面意外后果的研究却很少。为了优化 PM 系统，需要更好地了解发生的负面意外后果的类型及其因果前因。目标(1) 识别 PM 系统对患者造成的意外负面后果。 (2) 制定 PM 系统、设施层面变量（当地实施策略、初级保健人员态度和行为）以及对患者的意外负面影响之间的假设关系的概念框架。设计、参与者、方法使用不同病例抽样的定性研究设计。 2009 年 2 月至 7 月期间，在四个退伍军人健康管理局 (VHA) 设施中进行了 59 次面对面的个人半结构化访谈。参与者包括初级保健工作人员和设施领导。选择地点是为了确保服务的退伍军人数量和国家 VHA 绩效衡量标准的设施分数的可变性。采访被记录、转录和内容编码，以确定主题类别和关系。结果参与者注意到 PM 的积极影响和消极的意外后果。我们报告了给患者带来的三种意想不到的负面后果。绩效衡量可能（1）导致不适当的临床护理，（2）减少提供者对患者问题和患者服务的关注，以及（3）损害患者教育和自主权。我们还举例说明了对初级保健团队动态产生负面影响的例子。在许多情况下，这些问题源于为响应国家 PM 定义和政策而制定的当地实施策略。结论为实施国家 PM 系统而采取的设施级策略可能会导致不适当的临床护理，可能会分散医疗服务提供者对患者关注的注意力，并可能对患者教育和自主权产生负面影响。需要进一步研究来确定集中式 PM 系统的特征如何影响措施是否由设施本地转化为或多或少以患者为中心的政策和流程。
ABSTRACTBACKGROUNDAlthough benefits of performance measurement (PM) systems have been well documented, there is little research on negative unintended consequences of performance measurement systems in primary care. To optimize PM systems, a better understanding is needed of the types of negative unintended consequences that occur and of their causal antecedents.OBJECTIVES(1) Identify unintended negative consequences of PM systems for patients. (2) Develop a conceptual framework of hypothesized relationships between PM systems, facility-level variables (local implementation strategies, primary care staff attitudes and behaviors), and unintended negative effects on patients.DESIGN, PARTICIPANTS, APPROACHQualitative study design using dissimilar cases sampling. A series of 59 in-person individual semi-structured interviews at four Veterans Health Administration (VHA) facilities was conducted between February and July 2009. Participants included members of primary care staff and facility leaders. Sites were selected to assure variability in the number of veterans served and facility scores on national VHA performance measures. Interviews were recorded, transcribed and content coded to identify thematic categories and relationships.RESULTSParticipants noted both positive effects and negative unintended consequences of PM. We report three negative unintended consequences for patients. Performance measurement can (1) lead to inappropriate clinical care, (2) decrease provider focus on patient concerns and patient service, and (3) compromise patient education and autonomy. We also illustrate examples of negative consequences on primary care team dynamics. In many instances these problems originate from local implementation strategies developed in response to national PM definitions and policies.CONCLUSIONSFacility-level strategies undertaken to implement national PM systems may result in inappropriate clinical care, can distract providers from patient concerns, and may have a negative effect on patient education and autonomy. Further research is needed to ascertain how features of centralized PM systems influence whether measures are translated locally by facilities into more or less patient-centered policies and processes.
影响因子：
120.7
作者：
Boyd, CM;Darer, J;Wu, AW
通讯作者：
Wu, AW