研究:医疗护理按表现计薪并不总是管用
文章来源:未知 文章作者:meng 发布时间:2009-11-24 05:37 字体: [ ]  进入论坛
(单词翻译:双击或拖选)

Like everybody, health care professionals enjoy a pay raise for a job well done. But in some instances, financial incentives1(财务诱因) for health care performance may actually backfire(产生反效果). A new UCLA study shows that patient-care performance ratings for 25 medical groups across California improved significantly following the launch of a statewide pay-for-performance program in 2004 — but not when incentives(刺激,奖励) focused on doctors' productivity.

Reporting in the December edition of the Journal of General Internal Medicine, Hector P. Rodriguez, assistant professor in the department of health services at the UCLA School of Public Health, and colleagues found evidence that certain kinds of financial incentives for the purpose of improving patient care, in combination with public reporting of medical group performance ratings, have a positive effect on patient care experiences. However, they also found that some types of incentives may have a negative overall impact on how patients experienced their care.

The researchers analyzed2 how medical group performance ratings changed over time and found that ratings in specific measures representing three broad categories — physician communication, care coordination3(协调,调和) and office-staff interactions — improved substantially during the period after the start of the Integrated Healthcare Association's (IHA) pay-for-performance program. Incentives for addressing the quality of patient-clinician interaction and the overall experience of patient care tended to result in improved performance in those three areas, especially when the additional funds were used broadly by medical groups to positively4 reinforce a patient-centered work culture.

However, the greatest improvements were seen within those groups which placed less emphasis on physician productivity and greater emphasis on clinical quality and patient experience. And within groups where financial incentives were paid directly to physicians — rather than being used more broadly — the researchers found that placing too much emphasis on physician productivity actually had a negative impact on the experiences patients had when visiting their primary care doctor.

"As the Obama administration and Congress continue to grapple with(克服,解决) health care reform, these findings provide timely information about the kinds of things medical groups can do — and can avoid doing — with financial incentives in order to improve the quality of patient health care experiences," said Rodriguez, the lead author of the study.

For the study, researchers looked at information collected from 124,021 patients of 1,444 primary care physicians at 25 California medical groups between 2003 and 2006 and conducted interviews with group medical directors to determine how financial incentives were used. All 25 groups, which represent six insurers, were awarded financial incentives for achievements in the broad categories of clinical care processes, patient care experiences and office-based information systems, in accordance with(符合,一致) the IHA program, which was launched in 2004 with the goal of improving health care quality in California.

Medical groups were free to use the additional funds in various ways, with some groups paying incentives directly to physicians, and others using the incentives more broadly, with a focus on organizational priorities. The groups also participated in a public reporting program in which ratings in two of the three broad categories were released annually5 to the public in the form of a "health care report card" comparing the performance of the medical groups and insurers to one another.

"The current House bill being debated includes the establishment of a Center for Quality Improvement to identify and implement6 the best practices in the delivery of care," Rodriguez said. "Our study results suggest that the nature of financial incentives can affect the provision(规定,条款) of patient-centered care. Therefore, quality improvement and reimbursement7(偿还,赔偿) reform efforts should integrate(整合,一体化) patient-reported experiences of care as a central metric(度量标准) for evaluating reform effects."



点击收听单词发音收听单词发音  

1 incentives 884481806a10ef3017726acf079e8fa7     
激励某人做某事的事物( incentive的名词复数 ); 刺激; 诱因; 动机
参考例句:
  • tax incentives to encourage savings 鼓励储蓄的税收措施
  • Furthermore, subsidies provide incentives only for investments in equipment. 更有甚者,提供津贴仅是为鼓励增添设备的投资。 来自英汉非文学 - 环境法 - 环境法
2 analyzed 483f1acae53789fbee273a644fdcda80     
v.分析( analyze的过去式和过去分词 );分解;解释;对…进行心理分析
参考例句:
  • The doctors analyzed the blood sample for anemia. 医生们分析了贫血的血样。 来自《简明英汉词典》
  • The young man did not analyze the process of his captivation and enrapturement, for love to him was a mystery and could not be analyzed. 这年轻人没有分析自己蛊惑著迷的过程,因为对他来说,爱是个不可分析的迷。 来自《简明英汉词典》
3 coordination Ho8zt     
n.协调,协作
参考例句:
  • Gymnastics is a sport that requires a considerable level of coordination.体操是一项需要高协调性的运动。
  • The perfect coordination of the dancers and singers added a rhythmic charm to the performance.舞蹈演员和歌手们配合得很好,使演出更具魅力。
4 positively vPTxw     
adv.明确地,断然,坚决地;实在,确实
参考例句:
  • She was positively glowing with happiness.她满脸幸福。
  • The weather was positively poisonous.这天气着实讨厌。
5 annually VzYzNO     
adv.一年一次,每年
参考例句:
  • Many migratory birds visit this lake annually.许多候鸟每年到这个湖上作短期逗留。
  • They celebrate their wedding anniversary annually.他们每年庆祝一番结婚纪念日。
6 implement WcdzG     
n.(pl.)工具,器具;vt.实行,实施,执行
参考例句:
  • Don't undertake a project unless you can implement it.不要承担一项计划,除非你能完成这项计划。
  • The best implement for digging a garden is a spade.在花园里挖土的最好工具是铁锹。
7 reimbursement lkpzR4     
n.偿还,退还
参考例句:
  • He received reimbursement for his travel expenses.由于出差的花费他可以得到公司的补偿。
  • Which forms do I need to complete for my travel reimbursement?我需要填什么表来报我的旅费?
TAG标签: health care performance
发表评论
请自觉遵守互联网相关的政策法规,严禁发布色情、暴力、反动的言论。
评价:
表情:
验证码:点击我更换图片