NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK.
BMJ Open. 2013 Aug 2;3(8):e003190. doi: 10.1136/bmjopen-2013-003190.
To investigate the relationship between performance on the UK Quality and Outcomes Framework pay-for-performance scheme and choice of clinical computer system.
Retrospective longitudinal study.
Data for 2007-2008 to 2010-2011, extracted from the clinical computer systems of general practices in England.
All English practices participating in the pay-for-performance scheme: average 8257 each year, covering over 99% of the English population registered with a general practice.
Levels of achievement on 62 quality-of-care indicators, measured as: reported achievement (levels of care after excluding inappropriate patients); population achievement (levels of care for all patients with the relevant condition) and percentage of available quality points attained. Multilevel mixed effects multiple linear regression models were used to identify population, practice and clinical computing system predictors of achievement.
Seven clinical computer systems were consistently active in the study period, collectively holding approximately 99% of the market share. Of all population and practice characteristics assessed, choice of clinical computing system was the strongest predictor of performance across all three outcome measures. Differences between systems were greatest for intermediate outcomes indicators (eg, control of cholesterol levels).
Under the UK's pay-for-performance scheme, differences in practice performance were associated with the choice of clinical computing system. This raises the question of whether particular system characteristics facilitate higher quality of care, better data recording or both. Inconsistencies across systems need to be understood and addressed, and researchers need to be cautious when generalising findings from samples of providers using a single computing system.
研究英国质量和结果框架绩效付费计划的实施情况与临床计算机系统选择之间的关系。
回顾性纵向研究。
2007-2008 年至 2010-2011 年的数据，从英格兰全科医生临床计算机系统中提取。
所有参与绩效付费计划的英国实践：每年平均 8257 个，覆盖了超过 99%的在全科医生处注册的英国人口。
62 项医疗质量指标的达标水平，衡量指标为：报告的达标情况（排除不适当患者后的护理水平）；人群达标情况（所有符合相关条件的患者的护理水平）和可获得质量点的百分比。采用多层次混合效应多元线性回归模型来确定人群、实践和临床计算系统对达标情况的预测因素。
在研究期间，有 7 种临床计算机系统一直处于活跃状态，它们共同占据了约 99%的市场份额。在所评估的所有人群和实践特征中，临床计算系统的选择是所有三种结果衡量指标中表现的最强预测因素。系统之间的差异最大的是中间结果指标（例如，胆固醇水平的控制）。
在英国的绩效付费计划下，实践绩效的差异与临床计算机系统的选择有关。这就提出了一个问题，即特定的系统特征是否有助于提高护理质量、改善数据记录或两者兼而有之。需要了解和解决系统之间的不一致性，研究人员在从使用单一计算系统的提供者样本中推广发现时需要谨慎。
