Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study.
Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study.
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DOI：
10.1136/bmj.d108
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发表时间：
2011-01-25
期刊：
影响因子：
--
通讯作者：
Soumerai SB
中科院分区：
文献类型：
--
作者：
Serumaga B;Ross-Degnan D;Avery AJ;Elliott RA;Majumdar SR;Zhang F;Soumerai SB
目的 评估绩效薪酬激励对英国初级保健高血压患者的护理质量和结果的影响。设计中断时间序列。设置英国健康改善网络 (THIN) 数据库。参与者 2000 年 1 月至 2007 年 8 月期间诊断出的 470-725 名高血压患者。 干预措施 英国按绩效付费奖励（质量和结果框架），该框架于 2004 年 4 月实施，其中包括全科医生为高血压（和其他疾病）患者提供高质量护理的具体目标。主要结果衡量随着时间的推移收缩压和舒张压的百分位、血压监测率、血压控制以及基线（48 个月）和实施绩效工资后 36 个月每月间隔的治疗强度。对新接受治疗（按绩效付费前六个月开始治疗）和已接受治疗（2001 年 1 月之前一年开始治疗）患者亚组的主要高血压相关结局和全因死亡率的累积发生率进行检查，以检查疾病的不同阶段。结果 考虑长期趋势后，血压监测没有变化（水平变化 0.85，95% 置信区间 -3.04 至 4.74，P=0.669，趋势变化 -0.01，-0.24 至 0.21，P=0.615），对照（-1.19，-2.06 至 1.09，P=0.109 和 -0.01，-0.06）至0.03，P=0.569）或治疗强度（0.67，-1.27至2.81，P=0.412和0.02，-0.23至0.19，P=0.706）可归因于绩效薪酬。在经历过治疗和新治疗的亚组中，按绩效付费对中风、心肌梗塞、肾衰竭、心力衰竭或全因死亡率的累积发生率没有影响。结论 在实行按绩效付费之前，高血压的良好护理质量是稳定的或有所改善。按绩效付费对护理过程或高血压相关的临床结果没有明显影响。英国按绩效付费政策设计的慷慨的经济激励措施可能不足以改善高血压和其他常见慢性病的护理质量和结果。
Objective To assess the impact of a pay for performance incentive on quality of care and outcomes among UK patients with hypertension in primary care. Design Interrupted time series. Setting The Health Improvement Network (THIN) database, United Kingdom. Participants 470 725 patients with hypertension diagnosed between January 2000 and August 2007. Intervention The UK pay for performance incentive (the Quality and Outcomes Framework), which was implemented in April 2004 and included specific targets for general practitioners to show high quality care for patients with hypertension (and other diseases). Main outcome measures Centiles of systolic and diastolic blood pressures over time, rates of blood pressure monitoring, blood pressure control, and treatment intensity at monthly intervals for baseline (48 months) and 36 months after the implementation of pay for performance. Cumulative incidence of major hypertension related outcomes and all cause mortality for subgroups of newly treated (treatment started six months before pay for performance) and treatment experienced (started treatment in year before January 2001) patients to examine different stages of illness. Results After accounting for secular trends, no changes in blood pressure monitoring (level change 0.85, 95% confidence interval −3.04 to 4.74, P=0.669 and trend change −0.01, −0.24 to 0.21, P=0.615), control (−1.19, −2.06 to 1.09, P=0.109 and −0.01, −0.06 to 0.03, P=0.569), or treatment intensity (0.67, −1.27 to 2.81, P=0.412 and 0.02, −0.23 to 0.19, P=0.706) were attributable to pay for performance. Pay for performance had no effect on the cumulative incidence of stroke, myocardial infarction, renal failure, heart failure, or all cause mortality in both treatment experienced and newly treated subgroups. Conclusions Good quality of care for hypertension was stable or improving before pay for performance was introduced. Pay for performance had no discernible effects on processes of care or on hypertension related clinical outcomes. Generous financial incentives, as designed in the UK pay for performance policy, may not be sufficient to improve quality of care and outcomes for hypertension and other common chronic conditions.
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3.4
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120.7
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