From VA Portland Health Care System, and Oregon Health & Science University, Portland, Oregon, and RAND Corporation, Santa Monica, California.
Ann Intern Med. 2017 Mar 7;166(5):341-353. doi: 10.7326/M16-1881. Epub 2017 Jan 10.
The benefits of pay-for-performance (P4P) programs are uncertain.
To update and expand a prior review examining the effects of P4P programs targeted at the physician, group, managerial, or institutional level on process-of-care and patient outcomes in ambulatory and inpatient settings.
PubMed from June 2007 to October 2016; MEDLINE, PsycINFO, CINAHL, Business Economics and Theory, Business Source Elite, Scopus, Faculty of 1000, and Gartner Research from June 2007 to February 2016.
Trials and observational studies in ambulatory and inpatient settings reporting process-of-care, health, or utilization outcomes.
Two investigators extracted data, assessed study quality, and graded the strength of the evidence.
Among 69 studies, 58 were in ambulatory settings, 52 reported process-of-care outcomes, and 38 reported patient outcomes. Low-strength evidence suggested that P4P programs in ambulatory settings may improve process-of-care outcomes over the short term (2 to 3 years), whereas data on longer-term effects were limited. Many of the positive studies were conducted in the United Kingdom, where incentives were larger than in the United States. The largest improvements were seen in areas where baseline performance was poor. There was no consistent effect of P4P on intermediate health outcomes (low-strength evidence) and insufficient evidence to characterize any effect on patient health outcomes. In the hospital setting, there was low-strength evidence that P4P had little or no effect on patient health outcomes and a positive effect on reducing hospital readmissions.
Few methodologically rigorous studies; heterogeneous population and program characteristics and incentive targets.
Pay-for-performance programs may be associated with improved processes of care in ambulatory settings, but consistently positive associations with improved health outcomes have not been demonstrated in any setting.
U.S. Department of Veterans Affairs.
绩效薪酬（P4P）计划的好处尚不确定。
更新并扩展先前的一项审查，该审查检查了针对医生、团体、管理或机构层面的 P4P 计划对门诊和住院环境中的医疗保健过程和患者结局的影响。
2007 年 6 月至 2016 年 10 月期间的 PubMed；2007 年 6 月至 2016 年 2 月期间的 MEDLINE、PsycINFO、CINAHL、商业经济学和理论、商业资源全文数据库、Scopus、Faculty of 1000、Gartner Research。
报告医疗保健过程、健康或使用结果的门诊和住院环境中的试验和观察性研究。
两名研究人员提取数据、评估研究质量并对证据强度进行分级。
在 69 项研究中，有 58 项在门诊环境中进行，52 项报告了医疗保健过程的结果，38 项报告了患者的结果。低强度证据表明，门诊环境中的 P4P 计划可能在短期内（2 至 3 年）改善医疗保健过程的结果，而关于长期效果的数据有限。许多积极的研究是在英国进行的，那里的激励措施比美国更大。在基线表现不佳的领域，取得了最大的改善。P4P 对中间健康结果没有一致的影响（低强度证据），也没有足够的证据来描述其对患者健康结果的任何影响。在医院环境中，低强度证据表明，P4P 对患者健康结果几乎没有或没有影响，但对减少医院再入院有积极影响。
方法学严格的研究较少；人群和计划特征以及激励目标存在异质性。
P4P 计划可能与改善门诊环境中的医疗保健过程有关，但在任何环境中都没有证明与改善健康结果有一致的关联。
美国退伍军人事务部。
