Gorman Trina, Arce Pia, O'Malley Gabrielle, Kambeu Taurai, Maponga Brian, Mavudze Jabulani, Xaba Sinokuthemba, Ncube Getrude, Hernandez Bernardo
Department of Global Health, University of Washington, Seattle, WA, USA.
Gorman Consulting, Edmonds, WA, USA.
BMC Health Serv Res. 2025 May 28;25(1):768. doi: 10.1186/s12913-025-12599-8.
While most Performance Based Financing (PBF) programs perform community verifications to confirm patients received reported services, many focus analysis and payment calculations on facility record verification due to their lower cost. Risk-based sampling can reduce the cost of community verifications by targeting areas with the highest risk of overreporting but there is little research on the factors associated with risk to guide sampling decisions.
This study explores facility-level and district-level factors associated with overreporting within a PBF setting.
Using community verification data from a Voluntary Medical Male Circumcision (VMMC) program in Zimbabwe, we estimated two binary outcomes with generalized mixed effects models. Our primary outcome is a measure of overreporting, defined as when interviewed patients did not plausibly confirm receipt of the VMMC. Additionally, we assessed factors associated with patients who were selected but ultimately not interviewed. We employed inverse probability of treatment weighting to address non-response and bootstrapping-based multiple imputation to address missingness.
We found that patients in the target age range, which were compensated at a higher price point, were less likely to be interviewed and over two times more likely to be classified as overreported compared to patients outside this age range (OR: 2.92, 95% CI: 2.38-3.59). Patients from outside the fixed health facility were more likely to be interviewed and less likely to be classified as overreported. In-person interviews as opposed to phone interviews appeared to be a worthwhile investment (OR: 1.61, 95% CI: 1.20-2.16).
We identified various factors that were associated with unsubstantiated VMMCs to inform risk-based sampling; however, our findings also suggest potential data fabrication. Programs should consider employing similar methods to reduce costs and increase the use of community verification data.
虽然大多数基于绩效的融资（PBF）项目会进行社区核查以确认患者是否接受了所报告的服务，但由于成本较低，许多项目将分析和支付计算重点放在机构记录核查上。基于风险的抽样可以通过针对高报告风险地区来降低社区核查成本，但关于与风险相关的因素以指导抽样决策的研究很少。
本研究探讨在PBF环境中与高报相关的机构层面和地区层面因素。
利用津巴布韦自愿男性包皮环切术（VMMC）项目的社区核查数据，我们用广义混合效应模型估计了两个二元结果。我们的主要结果是高报的一种衡量标准，定义为接受访谈的患者无法合理确认接受VMMC服务的情况。此外，我们评估了与被选中但最终未接受访谈的患者相关的因素。我们采用治疗加权的逆概率来处理无应答情况，并采用基于Bootstrap的多重插补来处理缺失值。
我们发现，目标年龄范围内以较高价格获得补偿的患者接受访谈的可能性较小，与该年龄范围外的患者相比，被归类为高报的可能性高出两倍多（比值比：2.92，95%置信区间：2.38 - 3.59）。来自固定医疗机构以外的患者接受访谈的可能性更大，被归类为高报的可能性更小。与电话访谈相比，面对面访谈似乎是一项值得的投资（比值比：1.61，95%置信区间：1.20 - 2.16）。
我们确定了与未经证实的VMMC相关的各种因素，以为基于风险的抽样提供信息；然而，我们的研究结果也表明存在潜在的数据造假情况。各项目应考虑采用类似方法来降低成本并增加社区核查数据的使用。
