Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen 6500 HB, The Netherlands.
Fam Pract. 2013 Apr;30(2):161-71. doi: 10.1093/fampra/cms055. Epub 2012 Sep 20.
Evidence for pay-for-performance (P4P) has been searched for in the last decade as financial incentives increased to influence behaviour of health care professionals to improve quality of care. The effectiveness of P4P is inconclusive, though some reviews reported significant effects.
To assess changes in performance after introducing a participatory P4P program.
An observational study with a pre- and post-measurement. Setting and subjects. Sixty-five general practices in the south of the Netherlands. Intervention. A P4P program designed by target users containing indicators for chronic care, prevention, practice management and patient experience (general practitioner's [GP] functioning and organization of care). Quality indicators were calculated for each practice. A bonus with a maximum of 6890 Euros per 1000 patients was determined by comparing practice performance with a benchmark.
Quality indicators for clinical care (process and outcome) and patient experience.
We included 60 practices. After 1 year, significant improvement was shown for the process indicators for all chronic conditions ranging from +7.9% improvement for cardiovascular risk management to +11.5% for asthma. Five outcome indicators significantly improved as well as patients' experiences with GP's functioning and organization of care. No significant improvements were seen for influenza vaccination rate and the cervical cancer screening uptake. The clinical process and outcome indicators, as well as patient experience indicators were affected by baseline measures. Smaller practices showed more improvement.
A participatory P4P program might stimulate quality improvement in clinical care and improve patient experiences with GP's functioning and the organization of care.
过去十年中，随着金融激励措施的增加，以影响医疗保健专业人员的行为来提高医疗质量，人们一直在寻找针对按效付费（P4P）的证据。尽管一些综述报告称有显著效果，但 P4P 的有效性尚无定论。
评估引入参与式 P4P 计划后绩效的变化。
一项观察性研究，具有前后测量。
荷兰南部的 65 家普通诊所。
由目标用户设计的 P4P 计划，其中包含慢性病护理、预防、实践管理和患者体验（全科医生的[GP]功能和护理组织）的指标。为每个实践计算了质量指标。通过将实践表现与基准进行比较，确定了最高可达每个患者 6890 欧元的奖金。
临床护理（过程和结果）和患者体验的质量指标。
我们纳入了 60 家实践。1 年后，所有慢性疾病的过程指标均显示出显著改善，从心血管风险管理的+7.9%改善到哮喘的+11.5%。五个结果指标也显著改善，以及患者对 GP 功能和护理组织的体验。流感疫苗接种率和宫颈癌筛查率没有显著提高。临床过程和结果指标以及患者体验指标均受基线措施的影响。较小的实践显示出更大的改善。
参与式 P4P 计划可能会刺激临床护理质量的提高，并改善患者对 GP 功能和护理组织的体验。
