The impact of financial incentives to improve quality indicators in patients with diabetes in Swiss primary care: a protocol for a cluster randomised controlled trial.
The impact of financial incentives to improve quality indicators in patients with diabetes in Swiss primary care: a protocol for a cluster randomised controlled trial.
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DOI：
10.1136/bmjopen-2018-023788
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发表时间：
2018-06-30
期刊：
影响因子：
2.9
通讯作者：
Chmiel C
中科院分区：
文献类型：
--
作者：
Meier R;Muheim L;Senn O;Rosemann T;Chmiel C
关于绩效工资(P4P)方案的有效性，只有有限且相互矛盾的证据，尽管它们可能有潜力改善指南的遵从性和护理质量。因此，我们的目标是在瑞士初级保健实践中测试P4P干预，重点是糖尿病患者治疗中的质量指标(QI)成就。这是一项以初级保健实践为随机单位的整群随机双臂干预研究。对照组将收到双月反馈报告，其中包含最新的血压和糖化血红蛋白(HbA1c)测量数据。干预组还将被告知QI成绩每提高一个百分点就会获得经济奖励。主要结果是两组在过程(HbA1c测量)和临床QI(血压控制)方面的差异。此外，我们还考察了财务激励对非激励性QI的影响以及对财务激励可持续性的影响。参加FIRE(使用电子病历的家庭医学ICPC研究)研究网络的瑞士初级保健实践有资格参加。FIRE数据库由来自瑞士初级保健实践的匿名结构化医疗常规数据组成。根据POWER计算，对数据库有贡献的70名全科医生将在这两组中的任何一组中随机进行。根据苏黎世州地方伦理委员会的说法，该项目不属于人体研究法律的范围，因此不需要获得伦理上的同意。研究结果将发表在同行评议的期刊上。ISRCTN13305645；预告。
There is only limited and conflicting evidence on the effectiveness of Pay-for-Performance (P4P) programmes, although they might have the potential to improve guideline adherence and quality of care. We therefore aim to test a P4P intervention in Swiss primary care practices focusing on quality indicators (QI) achievement in the treatment of patients with diabetes. This is a cluster-randomised, two-armed intervention study with the primary care practice as unit of randomisation. The control group will receive bimonthly feedback reports containing last data of blood pressure and glycated haemoglobin (HbA1c) measurements. The intervention group will additionally be informed about a financial incentive for each percentage point improved in QI achievement. Primary outcomes are differences in process (measurement of HbA1c) and clinical QI (blood pressure control) between the two groups. Furthermore, we investigate the effect on non-incentivised QIs and on sustainability of the financial incentives. Swiss primary care practices participating in the FIRE (Family Medicine ICPC Research using Electronic Medical Record) research network are eligible for participation. The FIRE database consists of anonymised structured medical routine data from Swiss primary care practices. According to power calculations, 70 of the general practitioners contributing to the database will be randomised in either of the groups. According to the Local Ethics Committee of the Canton of Zurich, the project does not fall under the scope of the law on human research and therefore no ethical consent is necessary. Results will be published in a peer-reviewed journal. ISRCTN13305645; Pre-results.