Campbell Stephen M, McDonald Ruth, Lester Helen
National Primary Care Research and Development Centre, the University of Manchester, Manchester, UK.
Ann Fam Med. 2008 May-Jun;6(3):228-34. doi: 10.1370/afm.844.
We conducted an in-depth exploration of family physicians' and nurses' beliefs and concerns about changes to the family health care service as a result of the new pay-for-performance scheme in the United Kingdom (Quality and Outcomes Framework [QOF]).
Using a semistructured interview format, we interviewed 21 family doctors and 20 nurses in 22 nationally representative practices across England between February and August 2007.
Participants believed the financial incentives had been sufficient to change behavior and to achieve targets. The findings suggest that it is not necessary to align targets to professional priorities and values to obtain behavior change, although doing so enhances enthusiasm and understanding. Participants agreed that the aims of the pay-for-performance scheme had been met in terms of improvements in disease-specific processes of patient care and physician income, as well as improved data capture. It also led to unintended effects, such as the emergence of a dual QOF-patient agenda within consultations, potential deskilling of doctors as a result of the enhanced role for nurses in managing long-term conditions, a decline in personal/relational continuity of care between doctors and patients, resentment by team members not benefiting financially from payments, and concerns about an ongoing culture of performance monitoring in the United Kingdom.
The QOF scheme may have achieved its declared objectives of improving disease-specific processes of patient care through the achievement of clinical and organizational targets and increased physician income, but our findings suggest that it has changed the dynamic between doctors and nurses and the nature of the practitioner-patient consultation.
我们深入探究了英国新的绩效薪酬计划（质量与结果框架[QOF]）实施后，家庭医生和护士对家庭医疗服务变化的看法与担忧。
采用半结构化访谈形式，于2007年2月至8月间，在英格兰22个具有全国代表性的医疗机构中，对21名家庭医生和20名护士进行了访谈。
参与者认为经济激励足以改变行为并实现目标。研究结果表明，虽将目标与专业重点和价值观保持一致可增强积极性与理解，但要实现行为改变并非必须如此。参与者一致认为，在改善特定疾病的患者护理流程、提高医生收入以及改进数据收集方面，绩效薪酬计划的目标已达成。它还产生了一些意想不到的影响，比如在会诊中出现了QOF与患者双重议程，由于护士在管理长期病症方面作用增强导致医生可能出现技能退化，医生与患者之间个人/关系连续性护理的下降，未从薪酬中获得经济利益的团队成员产生不满，以及对英国持续存在的绩效监测文化的担忧。
QOF计划可能已通过实现临床和组织目标以及增加医生收入，达成了其宣称的改善特定疾病患者护理流程的目标，但我们的研究结果表明，它改变了医生与护士之间的动态关系以及医患咨询的性质。
