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一项针对临床医生转介患者至州戒烟热线的按绩效付费计划的随机试验。

A randomized trial of a pay-for-performance program targeting clinician referral to a state tobacco quitline.

作者信息

An Lawrence C, Bluhm James H, Foldes Steven S, Alesci Nina L, Klatt Colleen M, Center Bruce A, Nersesian William S, Larson Mark E, Ahluwalia Jasjit S, Manley Marc W

机构信息

Department of Internal Medicine, University of Minnesota, Minneapolis, MN 55455, USA.

出版信息

Arch Intern Med. 2008 Oct 13;168(18):1993-9. doi: 10.1001/archinte.168.18.1993.

Abstract

BACKGROUND

Tobacco quitlines offer clinicians a means to connect their patients with evidence-based treatments. Innovative methods are needed to increase clinician referral.

METHODS

This is a clinic randomized trial that compared usual care (n = 25 clinics) vs a pay-for-performance program (intervention) offering $5000 for 50 quitline referrals (n = 24 clinics). Pay-for-performance clinics also received monthly updates on their referral numbers. Patients were eligible for referral if they visited a participating clinic, were 18 years or older, currently smoked cigarettes, and intended to quit within the next 30 days. The primary outcome was the clinic's rate of quitline referral (ie, number of referrals vs number of smokers seen in clinic).

RESULTS

Pay-for-performance clinics referred 11.4% of smokers (95% confidence interval [CI], 8.0%-14.9%; total referrals, 1483) compared with 4.2% (95% CI, 1.5%-6.9%; total referrals, 441) for usual care clinics (P = .001). Rates of referral were similar in intervention vs usual care clinics (n = 9) with a history of being very engaged with quality improvement activities (14.1% vs 15.1%, respectively; P = .85). Rates were substantially higher in intervention vs usual care clinics with a history of being engaged (n = 22 clinics; 10.1% vs 3.0%; P = .001) or less engaged (n = 18 clinics; 10.1% vs 1.1%; P = .02) with quality improvement. The rate of patient contact after referral was 60.2% (95% CI, 49.7%-70.7%). Among those contacted, 49.4% (95% CI, 42.8%-55.9%) enrolled, representing 27.0% (95% CI, 21.3%-32.8%) of all referrals. The marginal cost per additional quitline enrollee was $300.

CONCLUSION

A pay-for-performance program increases referral to tobacco quitline services, particularly among clinics with a history of less engagement in quality improvement activities.

摘要

背景

戒烟热线为临床医生提供了一种途径,使他们的患者能够接受循证治疗。需要创新方法来增加临床医生的转诊。

方法

这是一项临床随机试验,比较了常规护理(25家诊所)与绩效付费计划(干预组),后者为50次戒烟热线转诊提供5000美元(24家诊所)。参与绩效付费的诊所还会每月收到其转诊数量的最新信息。如果患者前往参与试验的诊所就诊、年龄在18岁及以上、目前吸烟且打算在未来30天内戒烟,则符合转诊条件。主要结局是诊所的戒烟热线转诊率(即转诊数量与诊所中见到的吸烟者数量之比)。

结果

绩效付费诊所转诊了11.4%的吸烟者(95%置信区间[CI],8.0%-14.9%;总转诊数为1483),而常规护理诊所的转诊率为4.2%(95%CI,1.5%-6.9%;总转诊数为441)(P = 0.001)。在有积极参与质量改进活动历史的干预组与常规护理诊所(n = 9)中,转诊率相似(分别为14.1%和15.1%;P = 0.85)。在有参与质量改进历史(n = 22家诊所;10.1%对3.0%;P = 0.001)或较少参与质量改进历史(n = 18家诊所;10.1%对1.1%;P = 0.02)的干预组与常规护理诊所中,转诊率显著更高。转诊后患者的联系率为60.2%(95%CI,49.7%-70.7%)。在被联系的患者中,49.4%(95%CI,42.8%-55.9%)登记参加,占所有转诊患者的27.0%(95%CI,21.3%-32.8%)。每增加一名戒烟热线登记参与者的边际成本为300美元。

结论

绩效付费计划增加了对烟草戒烟热线服务的转诊,特别是在有较少参与质量改进活动历史的诊所中。

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