Raffray Maxime, Campéon Arnaud, Bricard Damien, Augé Estelle, Raynaud Denis, Couchoud Cécile, Frimat Luc, Bayat Sahar
CNRS, Inserm, Arènes-UMR 6051, RSMS-U1309, École des hautes études en sante publique, Rennes, France.
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Maria Aspmans Gata 22A, 171 64, Solna, Sweden.
J Nephrol. 2025 Apr 22. doi: 10.1007/s40620-025-02284-8.
France introduced a new payment model for care providers of patients with Chronic Kidney Disease (CKD) Grades 4 and 5: the CKD-Capitation Payment model. The model aims to financially incentivise multidisciplinary care for patients. We performed a qualitative study among participating providers to identify obstacles and facilitators of the model implementation as well as the initial benefits and potential policy improvements.
From March to July 2023, we collected data through semi-structured interviews with medical and managerial staff of facilities participating in the new model in France. We purposely selected a sample of facilities based on ownership status and CKD-Capitation Payment model activity data, including the number of patients reported. We performed a thematic analysis of the interview transcripts.
We interviewed 22 staff from 14 facilities. Interviews revealed that adapting the information systems to the model requirements was a major obstacle to implementation, undermining efficient medical time allocation and data quality. Securing facility management support and organising the care amid workforce shortages were additional obstacles. Despite these challenges, staff reported positively on the model, noting the increased time spent by nurses with patients and the assertion of dietitians' role. Interviewees reported the need for greater flexibility in visit requirements to better align with patient needs.
This study demonstrates how the new capitation payment model introduced in France can enable multidisciplinary and coordinated care for patients with CKD. However, supporting facilities in adopting interoperable information systems and increasing the flexibility of the model appear essential for long-term adoption.
法国为慢性肾脏病（CKD）4级和5级患者的护理提供者引入了一种新的支付模式：CKD人头付费模式。该模式旨在从经济上激励对患者进行多学科护理。我们对参与的提供者进行了一项定性研究，以确定该模式实施的障碍和促进因素，以及初始效益和潜在的政策改进。
2023年3月至7月，我们通过对法国参与新模式的医疗机构的医务人员和管理人员进行半结构化访谈来收集数据。我们根据所有权状况和CKD人头付费模式活动数据（包括报告的患者数量）有目的地选择了一组医疗机构样本。我们对访谈记录进行了主题分析。
我们采访了来自14家机构的22名工作人员。访谈显示，使信息系统适应模式要求是实施的一个主要障碍，影响了有效的医疗时间分配和数据质量。在劳动力短缺的情况下，获得机构管理支持和组织护理是另外的障碍。尽管存在这些挑战，工作人员对该模式给予了积极评价，指出护士与患者相处的时间增加，以及营养师的作用得到了确立。受访者报告说，需要在就诊要求上有更大的灵活性，以便更好地满足患者需求。
本研究表明法国引入的新人头付费模式如何能够为CKD患者提供多学科和协调的护理。然而，支持各机构采用可互操作的信息系统并提高模式的灵活性，对于长期采用该模式似乎至关重要。
