医生经济激励与临床路径依从性的关系：对中国 18 家公立医院的横断面研究。
Relationship between physician financial incentives and clinical pathway compliance: a cross-sectional study of 18 public hospitals in China.
机构信息
Hospital Management, School of Public Health, Fudan University, Shanghai, China.
CHC Key Lab of Health Technology Assessment (Fudan University), Shanghai, China.
出版信息
BMJ Open. 2019 May 28;9(5):e027540. doi: 10.1136/bmjopen-2018-027540.
OBJECTIVES
Many strategies have been either used or recommended to promote physician compliance with clinical practice guidelines and clinical pathways (CPs). This study examines the relationship between hospitals' use of financial incentives to encourage physician compliance with CPs and physician adherence to CPs.
DESIGN
A retrospectively cross-sectional study of the relationship between the extent to which patient care was consistent with CPs and hospital's use of financial incentives to influence CP compliance.
SETTING
Eighteen public hospitals in three provinces in China.
PARTICIPANTS
Stratified sample of 2521 patients discharged between 3 January 2013 and 31 December 2014.
PRIMARY OUTCOME MEASURES
The proportion of key performance indicators (KPIs) met for patients with (1) community-acquired pneumonia (pneumonia), (2) acute myocardial infarction (AMI), (3) acute left ventricular failure (heart failure), (4) planned caesarean section (C-section) and (5) gallstones associated with acute cholecystitis and associated cholecystectomy (cholecystectomy).
RESULTS
The average implementation rate of CPs for five conditions (pneumonia, AMI, heart failure, C-section and cholecystectomy) based on 2521 cases in 18 surveyed hospitals was 57% (ranging from 44% to 67%), and the overall average compliance rate for the KPIs for the five conditions was 69.48% (ranging from 65.07% to 77.36%). Implementation of CPs was associated with greater compliance within hospitals only when hospitals adopted financial incentives directed at physicians to promote compliance.
CONCLUSION
CPs are viewed as important strategies to improve medical care in China, but they have not been widely implemented or adhered to in Chinese public hospitals. In addition to supportive resources, education/training and better administration in general, hospitals should provide financial incentives to encourage physicians to adhere to CPs.
目的
为了提高医生对临床实践指南和临床路径（CPs）的依从性，已经采用或推荐了许多策略。本研究旨在探讨医院使用经济激励措施鼓励医生依从 CPs 与医生依从 CPs 之间的关系。
设计
一项回顾性的横断研究，旨在探讨患者护理与 CPs 的一致性程度与医院使用经济激励措施影响 CP 依从性之间的关系。
地点
中国三个省份的 18 家公立医院。
参与者
2013 年 1 月 3 日至 2014 年 12 月 31 日期间出院的 2521 名患者的分层样本。
主要结局测量指标
符合（1）社区获得性肺炎（肺炎）、（2）急性心肌梗死（AMI）、（3）急性左心室衰竭（心力衰竭）、（4）计划性剖宫产（C -section）和（5）与急性胆囊炎相关的胆囊结石和胆囊切除术（胆囊切除术）的关键绩效指标（KPI）的患者比例。
结果
基于 18 家调查医院的 2521 例病例，五种疾病（肺炎、AMI、心力衰竭、C -section 和胆囊切除术）的 CPs 实施率平均为 57%（范围为 44%至 67%），五种疾病的 KPI 总体平均依从率为 69.48%（范围为 65.07%至 77.36%）。只有当医院采取针对医生的经济激励措施来促进依从性时，CPs 的实施与医院内更高的依从性才相关。
结论
CPs 被视为改善中国医疗保健的重要策略，但在中国公立医院尚未得到广泛实施或遵守。除了提供支持性资源、教育/培训和一般管理外，医院还应提供经济激励措施，鼓励医生遵守 CPs。
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