Greaves Felix, Laverty Anthony A, Pape Utz, Ratneswaren Anenta, Majeed Azeem, Millett Christopher
Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK.
Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
J R Soc Med. 2015 May;108(5):171-83. doi: 10.1177/0141076815583303. Epub 2015 Apr 23.
Health system reforms in England are opening broad areas of clinical practice to new providers of care. As part of these reforms, new entrants--including private companies--have been allowed into the primary care market under 'alternative provider of medical services' contracting mechanisms since 2004. The characteristics and performance of general practices working under new alternative provider contracts are not well described. We sought to compare the quality of care provided by new entrant providers to that provided by the traditional model of general practice.
Open cohort study of English general practices. We used linear regression in cross-sectional and time series analyses, adjusting for practice and population characteristics, to compare quality in practices using alternative provider contracts to traditional practices. We created regression models using practice fixed effects to estimate the impact of practices changing to the new contract type.
The English National Health Service.
All general practices open from 2008/2009 to 2012/2013.
Seventeen established quality indicators--covering clinical effectiveness, efficiency, access and patient experience.
In total, 4.1% (347 of 8300) of general practices in England were run by alternative contract providers. These practices tended to be smaller, and serve younger, more diverse and more deprived populations than traditional providers. Practices run by alternative providers performed worse than traditional providers on 15 of 17 indicators after adjusting for practice and population characteristics (p < 0.01 for all). Switching to a new alternative provider contract did not result in improved performance.
The introduction of new alternative providers to deliver primary care services in England has not led to improvements in quality and may have resulted in worse care. Regulators should ensure that new entrants to clinical provider markets are performing to adequate standards and at least as well as traditional providers.
英国的医疗体系改革使广泛的临床实践领域向新的医疗服务提供者开放。作为这些改革的一部分，自2004年以来，包括私人公司在内的新进入者已通过“替代医疗服务提供者”签约机制进入初级医疗市场。目前对于依据新的替代提供者合同运营的全科医疗实践的特点和表现描述不足。我们试图比较新进入者提供的医疗服务质量与传统全科医疗模式提供的质量。
对英国全科医疗实践进行的开放队列研究。我们在横断面和时间序列分析中使用线性回归，并对实践和人口特征进行调整，以比较采用替代提供者合同的实践与传统实践的质量。我们使用实践固定效应创建回归模型，以估计实践转变为新合同类型的影响。
英国国家医疗服务体系。
2008/2009年至2012/2013年期间所有营业的全科医疗实践。
17项既定的质量指标，涵盖临床疗效、效率、可及性和患者体验。
在英国，总计4.1%（8300家中的347家）的全科医疗实践由替代合同提供者运营。这些实践往往规模较小，服务的人群比传统提供者更年轻、更多样化且更贫困。在对实践和人口特征进行调整后，替代提供者运营的实践在17项指标中的15项上表现不如传统提供者（所有指标p < 0.01）。转向新的替代提供者合同并未带来绩效改善。
在英国引入新的替代提供者来提供初级医疗服务并未带来质量提升，反而可能导致医疗服务变差。监管机构应确保临床提供者市场的新进入者达到适当标准，且至少与传统提供者表现相当。
