City of Espoo, Administration of Primary Care, Espoo, Finland.
Department of General Practice and Primary Healthcare, University of Helsinki, P.O. Box 20, Tukholmankatu 8 B, 00014 Helsinki, Finland.
Biomed Res Int. 2018 Feb 20;2018:4606710. doi: 10.1155/2018/4606710. eCollection 2018.
We studied whether primary care teams respond to financial group bonuses by improving the recording of diagnoses, whether this intervention leads to diagnoses reflecting the anticipated distribution of diseases, and how the recording of a significant chronic disease, diabetes, alters after the application of these bonuses.
We performed an observational register-based retrospective quasi-experimental follow-up study with before-and-after setting and two control groups in primary healthcare of a Finnish town. We studied the rate of recorded diagnoses in visits to general practitioners with interrupted time series analysis. The distribution of these diagnoses was also recorded.
After group bonuses, the rate of recording diagnoses increased by 17.9% (95% CI: 13.6-22.3) but not in either of the controls (-2.0 to -0.3%). The increase in the rate of recorded diagnoses in the care teams varied between 14.9% (4.7-25.2) and 33.7% (26.6-41.3). The distribution of recorded diagnoses resembled the respective distribution of diagnoses in the former studies of diagnoses made in primary care. The rate of recorded diagnoses of diabetes did not increase just after the intervention.
In primary care, the completeness of diagnosis recording can be, to varying degrees, influenced by group bonuses without guarantee that recording of clinically significant chronic diseases is improved.
我们研究了初级保健团队是否会通过改善诊断记录来回应财务分组奖金，这种干预是否会导致反映预期疾病分布的诊断结果，以及在应用这些奖金后，一种重要的慢性疾病（糖尿病）的记录如何改变。
我们在芬兰一个城镇的初级医疗保健中进行了一项基于观察的基于登记的回顾性准实验性随访研究，采用前后设置和两个对照组。我们使用中断时间序列分析来研究普通医生就诊中记录的诊断率。还记录了这些诊断的分布情况。
在分组奖金之后，记录诊断的比率增加了 17.9%（95%CI：13.6-22.3），但两个对照组均未增加（-2.0 至-0.3%）。护理团队中记录的诊断率增加幅度在 14.9%（4.7-25.2）至 33.7%（26.6-41.3）之间不等。记录的诊断分布与以前在初级保健中进行的诊断研究中的相应诊断分布相似。糖尿病的记录诊断率并没有在干预后立即增加。
在初级保健中，分组奖金可以在一定程度上影响诊断记录的完整性，但不能保证改善对临床重要的慢性疾病的记录。
