Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, room 1104, Boston, MA 02115, United States.
Department of Family Practice, University of British Columbia, David Strangway Bldg 5950 University Blvd 3rd Floor, Vancouver, BC V6T 2A1, Canada.
Int J Qual Health Care. 2024 Jun 24;36(2). doi: 10.1093/intqhc/mzae050.
To spur improvement in health-care service quality and quantity, performance-based financing (PBF) is an increasingly common policy tool, especially in low- and middle-income countries. This study examines how personnel diversity and affective bonds in primary care clinics affect their ability to improve care quality in PBF arrangements. Leveraging data from a large-scale matched PBF intervention in Tajikistan including 208 primary care clinics, we examined how measures of personnel diversity (position and tenure variety) and affective bonds (mutual support and group pride) were associated with changes in the level and variability of clinical knowledge (diagnostic accuracy of 878 clinical vignettes) and care processes (completion of checklist items in 2485 instances of direct observations). We interacted the explanatory variables with exposure to PBF in cluster-robust, linear regressions to assess how these explanatory variables moderated the PBF treatment's association with clinical knowledge and care process improvements. Providers and facilities with higher group pride exhibited higher care process improvement (greater checklist item completion and lower variability of items completed). Personnel diversity and mutual support showed little significant associations with the outcomes. Organizational features of clinics exposed to PBF may help explain variation in outcomes and warrant further research and intervention in practice to identify and test opportunities to leverage them. Group pride may strengthen clinics' ability to improve care quality in PBF arrangements. Improving health-care facilities' pride may be an affordable and effective way to enhance health-care organization adaptation.
为了提高医疗服务的质量和数量，基于绩效的融资（PBF）是一种越来越常见的政策工具，尤其是在中低收入国家。本研究考察了初级保健诊所中的人员多样性和情感联系如何影响它们在 PBF 安排中提高护理质量的能力。利用来自塔吉克斯坦一项大规模匹配 PBF 干预的数据，包括 208 个初级保健诊所，我们研究了人员多样性（职位和任期多样性）和情感联系（相互支持和团队自豪感）的措施与临床知识（878 个临床案例的诊断准确性）和护理过程（2485 次直接观察中检查表项目的完成情况）水平和变异性变化之间的关系。我们在聚类稳健的线性回归中对解释变量进行了交互作用，以评估这些解释变量如何调节 PBF 治疗与临床知识和护理过程改进之间的关联。具有较高团队自豪感的提供者和医疗机构表现出较高的护理过程改进（更多检查表项目的完成和完成项目的变异性较低）。人员多样性和相互支持与结果几乎没有显著关联。接触 PBF 的诊所的组织特征可能有助于解释结果的差异，并需要进一步在实践中进行研究和干预，以确定和测试利用这些特征的机会。团队自豪感可能会增强诊所在 PBF 安排中提高护理质量的能力。提高医疗保健设施的自豪感可能是增强医疗保健组织适应能力的一种经济实惠且有效的方法。
