Pavitt Sue H, Baxter Paul D, Brunton Paul A, Douglas Gail, Edlin Richard, Gibson Barry J, Godson Jenny, Hall Melanie, Porritt Jenny, Robinson Peter G, Vinall Karen, Hulme Claire
Centre for Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
Division of Biostatistics, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
BMJ Open. 2014 Sep 17;4(9):e005931. doi: 10.1136/bmjopen-2014-005931.
In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards 'blended contracts' that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England.
The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life.
The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national and international conferences and in international journals.
2006年在英格兰,新的牙科合同将牙科服务的委托工作下放到地方初级保健信托机构,以满足当地居民的需求。新的国家一般牙科服务合同(nGDS)基于根据护理复杂性划分的三个治疗级别所授予的牙科活动单位(UDA)进行支付。最近,英国牙科领域的合同模式正从基于工作量和病例复杂性的UDA模式向“混合合同”演变,这种混合合同包含与诸如质量和改善健康结果等关键绩效指标相关的激励措施。总体而言,激励驱动型医疗服务提供者合同有效性的证据仍在不断涌现。激励研究旨在评估一种混合合同模式(激励驱动型)与传统nGDS合同相比,在英格兰西约克郡的诊所中对牙科服务提供的影响。
激励模型采用混合方法全面评估一种新的激励驱动型国民保健服务牙科服务提供模式。该研究包括分布在三个新委托的牙科诊所(混合合同)和三个现有的传统诊所(nGDS合同)中的6家牙科手术室。新委托的诊所已根据贫困指数、年龄分布、种族、诊所规模和接收新患者情况与传统诊所进行了匹配。该研究由三个相互关联的工作包组成:一项定性研究,以探索利益相关者对新服务提供模式的看法;一项有效性研究,以评估激励模型在降低牙科疾病风险和数量以及提高患者口腔健康相关生活质量方面的效果;以及一项经济研究,以评估激励模型相对于临床状况和口腔健康相关生活质量的成本效益。
该研究已获得伦敦布罗姆利国家研究伦理服务委员会的批准。本研究的结果将在国内和国际会议以及国际期刊上发表。