Cabreira Fabiana da Silva, Hugo Fernando Neves, Celeste Roger Keller
Department of Preventive and Social Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Federal Institute of Education, Science and Technology Farroupilha - IFFar, Alegrete, Brazil.
Community Dent Oral Epidemiol. 2022 Feb;50(1):4-10. doi: 10.1111/cdoe.12717.
Evaluate the impact of a pay-for-performance program on changes in the number of dental procedures performed by public secondary dental care services in Brazil.
A longitudinal study was carried out with 932 public Dental Specialities Centres (Centro de Especialidades Odontológicas - CEO) that participated in the pay-for-performance Program for the Improvement of Access and Quality of Dental Specialities Centres Services (PMAQ/CEO) and 379 non-CEO centres with secondary dental production. The non-CEO and a group of CEOs did not receive financial incentives from the PMAQ-CEO and served as control groups. Three CEOs groups received additional financial incentives of 20%, 60% or 100% over maintenance values, based on their performance scores. The outcome was the increase (yes/no) in the number of dental procedures between 2011/2013 and 2015/2017. Analyses were carried out using logistic regressions.
The number of specialized procedures increased in 48.4% of the services, 44.6% among non-CEO, 52.3% among CEO with no financial incentive and 59.1% among CEO with 100% incentive. The fully adjusted model showed that CEOs receiving 100% of the financial incentive had greater odds of increasing the production of dental procedures (OR = 1.65, 95%CI: 1.09-2.51). Services that increased the number of specialist dentists had (OR = 2.35, 95%CI 1.88-2.94). Municipalities that increased in coverage of private dental insurance had OR = 0.98 (95%CI: 0.94-1.02), and those with higher coverage of primary dental care had OR = 1.02 (95%CI: 0.99-1.05).
Pay-for-performance may increase the production of dental procedures by CEOs, and mechanisms explaining it must be further investigated.
评估绩效薪酬计划对巴西公立二级牙科护理服务所实施牙科手术数量变化的影响。
对932家参与牙科专科中心服务获取与质量提升绩效薪酬计划（PMAQ/CEO）的公立牙科专科中心（Centro de Especialidades Odontológicas - CEO）以及379家有二级牙科业务的非CEO中心开展了一项纵向研究。非CEO中心和一组CEO中心未获得PMAQ-CEO的经济激励，作为对照组。三组CEO中心根据其绩效得分在维持值基础上额外获得20%、60%或100%的经济激励。结果是2011/2013年至2015/2017年期间牙科手术数量的增加（是/否）。使用逻辑回归进行分析。
48.4%的服务中专科手术数量增加，非CEO中心中为44.6%，无经济激励的CEO中心中为52.3%，有100%激励的CEO中心中为59.1%。完全调整模型显示，获得100%经济激励的CEO中心增加牙科手术量的几率更大（比值比=1.65，95%置信区间：1.09 - 2.51）。专科牙医数量增加的服务有（比值比=2.35，95%置信区间1.88 - 2.94）。私人牙科保险覆盖范围增加的市比值比=0.98（95%置信区间：0.94 - 1.02），初级牙科护理覆盖范围较高者比值比=1.02（95%置信区间：0.99 - 1.05）。
绩效薪酬可能会增加CEO中心的牙科手术量，对此的解释机制必须进一步研究。
