Valentelyte Gintare, Keegan Conor, Sorensen Jan
Structured Population and Health services Research Education (SPHeRE) Programme, Division of Population Health Sciences, Mercer Street Lower, Royal College of Surgeons in Ireland, Dublin, Ireland.
Healthcare Outcome Research Centre (HORC), Royal College of Surgeons in Ireland, Dublin, Ireland.
Health Econ Rev. 2021 May 18;11(1):17. doi: 10.1186/s13561-021-00315-1.
Activity-Based Funding (ABF) has been implemented across many countries as a means to incentivise efficient hospital care delivery and resource use. Previous reviews have assessed the impact of ABF implementation on a range of outcomes across health systems. However, no comprehensive review of the methods used to generate this evidence has been undertaken. The aim of this review is to identify and assess the analytical methods employed in research on ABF hospital performance outcomes.
We conducted a scoping review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Five academic databases and reference lists of included studies were used to identify studies assessing the impact of ABF on hospital performance outcomes. Peer-reviewed quantitative studies published between 2000 and 2019 considering ABF implementation outside the U.S. were included. Qualitative studies, policy discussions and commentaries were excluded. Abstracts and full text studies were double screened to ensure consistency. All analytical approaches and their relative strengths and weaknesses were charted and summarised.
We identified 19 studies that assessed hospital performance outcomes from introduction of ABF in England, Korea, Norway, Portugal, Israel, the Netherlands, Canada, Italy, Japan, Belgium, China, and Austria. Quasi-experimental methods were used across most reviewed studies. The most commonly used assessment methods were different forms of interrupted time series analyses. Few studies used difference-in-differences or similar methods to compare outcome changes over time relative to comparator groups. The main hospital performance outcome measures examined were case numbers, length of stay, mortality and readmission.
Non-experimental study designs continue to be the most widely used method in the assessment of ABF impacts. Quasi-experimental approaches examining the impact of ABF implementation on outcomes relative to comparator groups not subject to the reform should be applied where possible to facilitate identification of effects. These approaches provide a more robust evidence-base for informing future financing reform and policy.
基于活动的资金分配（ABF）已在许多国家实施，作为激励高效医院护理服务和资源利用的一种手段。以往的综述评估了ABF实施对整个卫生系统一系列结果的影响。然而，尚未对用于生成这一证据的方法进行全面综述。本综述的目的是识别和评估ABF医院绩效结果研究中所采用的分析方法。
我们按照系统评价与Meta分析扩展版的首选报告项目进行了一项范围综述。使用五个学术数据库和纳入研究的参考文献列表来识别评估ABF对医院绩效结果影响的研究。纳入了2000年至2019年间发表的、考虑美国以外地区ABF实施情况的同行评审定量研究。定性研究、政策讨论和评论被排除。对摘要和全文研究进行了双重筛选以确保一致性。绘制并总结了所有分析方法及其相对优缺点。
我们识别出19项评估在英格兰、韩国、挪威、葡萄牙、以色列、荷兰、加拿大、意大利、日本、比利时、中国和奥地利引入ABF后医院绩效结果的研究。大多数综述研究使用了准实验方法。最常用的评估方法是不同形式的中断时间序列分析。很少有研究使用差异-in-差异或类似方法来比较相对于对照群体随时间的结果变化。所考察的主要医院绩效结果指标是病例数、住院时间、死亡率和再入院率。
非实验性研究设计仍然是评估ABF影响最广泛使用的方法。应尽可能采用准实验方法来考察ABF实施相对于未进行改革的对照群体对结果的影响，以促进效应的识别。这些方法为为未来的融资改革和政策提供了更有力的证据基础。
