Effect of financial incentives on incentivised and non-incentivised clinical activities: longitudinal analysis of data from the UK Quality and Outcomes Framework.
Effect of financial incentives on incentivised and non-incentivised clinical activities: longitudinal analysis of data from the UK Quality and Outcomes Framework.
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DOI：
10.1136/bmj.d3590
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发表时间：
2011-06-28
期刊：
影响因子：
--
通讯作者：
Reeves D
中科院分区：
文献类型：
--
作者：
Doran T;Kontopantelis E;Valderas JM;Campbell S;Roland M;Salisbury C;Reeves D
目的调查英国全科医生的激励计划是否导致他们忽视了计划中未包括的活动。设计对从428个确定的护理质量指标中选择的42项活动（23项包括在激励计划中，19项不包括在内）的完成率进行纵向分析。在英格兰设置148个全科诊所（653 500例患者）。主要衡量指标根据奖励前阶段（2000-1至2002-3）的趋势预测的成就率，以及计划首三年（2004-5至2006-7）的实际成绩。结果在激励前，大部分指标的完成率均有所提高。在奖励计划实施的第一年（2004-5年），23项奖励指标中有22项的改善速度显著提高。在2004- 2005年之后，这些指标的成就达到了一个平台，但2006- 2007年的护理质量仍然高于14项激励指标的激励前趋势预测。在该计划实施的第一年，非奖励指标的改善速度并无整体效果，但到2006- 2007年，成就率明显低于奖励前趋势所预测的水平。结论2001年至2007年间，所有指标的质量都有了实质性的提高。与财政激励相关的改善似乎是以牺牲对没有激励的护理方面的微小有害影响为代价的。
Objective To investigate whether the incentive scheme for UK general practitioners led them to neglect activities not included in the scheme. Design Longitudinal analysis of achievement rates for 42 activities (23 included in incentive scheme, 19 not included) selected from 428 identified indicators of quality of care. Setting 148 general practices in England (653 500 patients). Main outcome measures Achievement rates projected from trends in the pre-incentive period (2000-1 to 2002-3) and actual rates in the first three years of the scheme (2004-5 to 2006-7). Results Achievement rates improved for most indicators in the pre-incentive period. There were significant increases in the rate of improvement in the first year of the incentive scheme (2004-5) for 22 of the 23 incentivised indicators. Achievement for these indicators reached a plateau after 2004-5, but quality of care in 2006-7 remained higher than that predicted by pre-incentive trends for 14 incentivised indicators. There was no overall effect on the rate of improvement for non-incentivised indicators in the first year of the scheme, but by 2006-7 achievement rates were significantly below those predicted by pre-incentive trends. Conclusions There were substantial improvements in quality for all indicators between 2001 and 2007. Improvements associated with financial incentives seem to have been achieved at the expense of small detrimental effects on aspects of care that were not incentivised.
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