利用经济激励和行为经济学来促使医生参与质量改进流程措施。
Leveraging financial incentives and behavioural economics to engage physicians in achieving quality-improvement process measures.
机构信息
From the Division of General Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Moloo, Lamb, Walsh, Musselman); the The Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo, Thavorn, Musselman, Forster); the School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lamb, Thavorn); the Division of Thoracic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Sundaresan); and the Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Forster)
From the Division of General Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Moloo, Lamb, Walsh, Musselman); the The Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo, Thavorn, Musselman, Forster); the School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Lamb, Thavorn); the Division of Thoracic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Sundaresan); and the Department of Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, Ont. (Forster).
出版信息
Can J Surg. 2022 Apr 27;65(2):E290-E295. doi: 10.1503/cjs.017320. Print 2022 Mar-Apr.
BACKGROUND
Dedicated quality-improvement (QI) initiatives within health care systems are of clear benefit, and physicians respond to financial incentivization. The Canadian health care system often lacks this lever, and many financially incentivized QI programs rely on traditional economic principles. We describe our evaluation of financial incentivization for the implementation of QI process metrics in a department of surgery at a Canadian academic hospital system and its impact over a 4-year period.
METHODS
Quality-improvement processes informed by extant QI incentivization literature and guided by the principles of behavioural economics were implemented within our institution's Department of Surgery. Disbursement of supplemental government funding was modified to be contingent on the ability of divisions within the department to meet predefined QI metrics, including regular multidisciplinary meetings, morbidity and mortality rounds with documented feedback of systemic issues to division members, reviews of adverse events, and implementation of annual patient experience projects. We evaluated the effect of the QI processes from 2015/16 to 2018/19.
RESULTS
There was a significant increase in the number of divisions that satisfied all the QI metrics over the study period, from 2 (28%) in 2015/16, to 5 (71%) in 2016/17, to 7 (100.0%) in 2017/18 and 2018/19 ( < 0.01). The application of behavioural economics principles, such as reward versus penalty payoff, loss aversion, payment separation, aligning of values, and relative social ranking, was important to the outcome of the study.
CONCLUSION
Incentivizing QI activities in the Canadian health care system is possible and led to improvement in QI processes as a whole in our department. This paper lays out a method of financial reimbursement to facilitate engagement of physicians and establishment of a foundation of important QI processes and measures within a department.
背景
医疗保健系统内专门的质量改进（QI）计划显然是有益的，并且医生对财务激励做出回应。加拿大的医疗保健系统通常缺乏这一手段，许多基于财务激励的 QI 计划依赖于传统的经济原则。我们描述了对加拿大学术医院系统外科部门实施 QI 过程指标的财务激励的评估，以及该计划在 4 年期间的影响。
方法
根据现有的 QI 激励文献和行为经济学的原则，在我们机构的外科部门实施了 QI 过程。修改了补充政府资金的发放方式，使其取决于部门内各科室实现预定义 QI 指标的能力，包括定期多学科会议、有系统问题文件记录反馈的发病率和死亡率评估、不良事件审查以及年度患者体验项目的实施。我们评估了 2015/16 年至 2018/19 年期间 QI 过程的效果。
结果
在研究期间，满足所有 QI 指标的科室数量显著增加，从 2015/16 年的 2 个（28%）增加到 2016/17 年的 5 个（71%），2017/18 年的 7 个（100.0%）和 2018/19 年的 7 个（100.0%）（<0.01）。应用行为经济学原则，如奖励与惩罚收益、损失厌恶、支付分离、价值观一致和相对社会排名，对研究结果很重要。
结论
在加拿大医疗保健系统中激励 QI 活动是可能的，并导致我们部门的 QI 过程整体得到改善。本文提出了一种财务报销方法，以促进医生的参与，并在部门内建立重要的 QI 过程和措施的基础。
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