Lund University School of Economics and Management, Lund, Sweden.
Int J Integr Care. 2014 Dec 15;14:e038. doi: 10.5334/ijic.1680. eCollection 2014 Oct.
A number of reforms have been implemented in Swedish health care to support integrated care for frail older people and to reduce utilization of hospital care by this group. Outcomes and process indicators have been used in pay-for-performance (P4P) schemes by both national and local governments to support developments.
To analyse limitations in the use of outcome and process indicators to incentivize integrated care for elderly patients with significant health care needs in the context of primary care.
Data were collected from the Region Skåne county council. Eight primary care providers and associated community services were compared in a ranking exercise based on information from interviews and registered data. Registered data from 150 primary care providers were analysed in regression models.
Both the ranking exercise and regression models revealed important problems related to risk-adjustment, attribution, randomness and measurement fixation when using indicators in P4P schemes and for external accountability purposes. Instead of using indicators in incentive schemes targeting individual providers, indicators may be used for diagnostic purposes and to support development of new knowledge, targeting local systems that move beyond organizational boundaries.
瑞典医疗保健领域实施了多项改革，以支持体弱老年人的综合护理，并减少该人群对医院护理的利用。国家和地方政府都在按绩效付费（P4P）计划中使用了结果和过程指标来支持发展。
分析在初级保健背景下，使用结果和过程指标激励为有重大医疗需求的老年患者提供综合护理方面的局限性。
数据来自斯科讷省议会。在基于访谈和登记数据的排名活动中，对八家初级保健提供者和相关社区服务进行了比较。对 150 家初级保健提供者的登记数据进行了回归模型分析。
排名活动和回归模型都揭示了在 P4P 计划中使用指标以及出于外部问责目的时，与风险调整、归因、随机性和衡量固定性相关的重要问题。指标可能用于诊断目的，并支持针对超越组织边界的本地系统的新知识发展，而不是将指标用于针对个别提供者的激励计划中。
