Checkland Kath, Harrison Stephen
Walport Clinical Lecturer in Primary Care, National Primary Care Research and Development Centre, University of Manchester, Manchester, UK.
Qual Prim Care. 2010;18(2):139-46.
In 2003, the new General Medical Services Contract introduced a pay-for-performance programme know as the Quality and Outcomes Framework (QOF) into UK general practice, with payment for meeting a number of both clinical and organisational quality standards.
To investigate in detail the impact of the QOF on practice organisation and service delivery.
Two linked qualitative case studies in England and Scotland, using interviews and observation to investigate in depth the impact of the QOF in four general medical practices.
A number of significant changes to practice organisation and service delivery were observed, including: changes to practice organisational structures; an increased role for information technology; a move towards a more biomedical form of medical care; and changes to roles and relationships, including the introduction of internal peer-review and surveillance. In spite of this, the practices maintained a narrative of 'no change', arguing that they had 'fitted QOF in' to their routines with little trouble.
2003年，新的全科医疗服务合同将一项名为质量与结果框架（QOF）的绩效付费计划引入英国全科医疗，根据达到一系列临床和组织质量标准的情况进行支付。
详细调查质量与结果框架对医疗机构和服务提供的影响。
在英格兰和苏格兰开展两项相互关联的定性案例研究，通过访谈和观察深入调查质量与结果框架在四家全科医疗机构中的影响。
观察到医疗机构和服务提供方面发生了一些重大变化，包括：医疗机构组织结构的变化；信息技术作用的增强；医疗服务向更具生物医学形式的转变；角色和关系的变化，包括引入内部同行评审和监督。尽管如此，这些医疗机构仍维持“没有变化”的说法，称它们已轻松地将质量与结果框架“融入”日常工作。
