Senior Research Fellow, Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK.
J R Soc Med. 2012 Nov;105(11):472-9. doi: 10.1258/JRSM.2012.120130. Epub 2012 Dec 13.
To explore trends in the clinical activity of hospital specialists in English National Health Service (NHS) hospitals, and test the effect of contract reform.
Retrospective secondary analysis of hospital episode statistics, describing trends and testing for a contract effect using multilevel interrupted time series analysis.
Ten surgical and medical specialties in English NHS hospitals from 1999 to 2009. Participants Hospital consultants on full time or maximum part-time English NHS hospitals.
A new contract offered to NHS consultants in October 2003, with higher pay alongside job planning and appraisal.
Inpatient finished consultant episodes (FCEs) per consultant per month, with and without accounting for case-mix differences.
In most specialties there was a statistically significant downward trend in FCEs per consultant per month. On average in the surgical specialties, FCEs reduced by 0.14 per month (95% CI -0.16 to -0.11) and in medicine there was a smaller reduction of 0.08 FCEs per month (95% CI -0.1 to -0.06). NHS patients symptoms have increased in severity over time, and the downward trend is reduced after case-mix-adjustment, and reversed in general and geriatric medicine. The effect of the contract on clinical activity was minimal. In five specialties there was no statistically significant effect, but in five specialties there was a statistically significant negative effect.
Consultant clinical activity, as measured by FCEs per month, has shown a general downward trend from 1999 to 2009. The consultant contract was not associated with an increase in consultant clinical activity rates.
探讨英国国家医疗服务体系（NHS）医院专科医生临床活动的趋势，并检验合同改革的效果。
对医院病例统计数据进行回顾性二次分析，描述趋势并使用多水平中断时间序列分析检验合同效应。
英国 NHS 医院的 10 个外科和内科专科，时间跨度为 1999 年至 2009 年。
全职或兼职的 NHS 顾问医院顾问。
2003 年 10 月为 NHS 顾问提供新合同，薪酬提高，同时进行工作规划和评估。
每月每位顾问的住院完成顾问诊疗（FCE），包括和不包括病例组合差异。
大多数专科的 FCE 每月每位顾问的数量均呈统计学意义的下降趋势。在外科专科中，FCE 平均每月减少 0.14（95%CI-0.16 至-0.11），而内科则减少 0.08 FCE/月（95%CI-0.1 至-0.06）。随着时间的推移，NHS 患者的症状严重程度有所增加，病例组合调整后下降趋势减弱，在普通和老年医学科中则出现逆转。合同对临床活动的影响微乎其微。在五个专科中没有统计学意义，但在五个专科中有统计学意义的负向影响。
以每月 FCE 衡量，1999 年至 2009 年期间，顾问的临床活动总体呈下降趋势。顾问合同与顾问临床活动率的增加无关。
