...
  • 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Journal of health services research & policy >Should pay-for-performance schemes be locally designed? evidence from the commissioning for quality and innovation (CQUIN) framework
【24h】

Should pay-for-performance schemes be locally designed? evidence from the commissioning for quality and innovation (CQUIN) framework

机译：绩效工资计划应该在本地设计吗？质量和创新（CQUIN）框架的调试证据

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

Objectives: It is increasingly recognized that the design characteristics of pay-for-performance schemes are important in determining their impact. One important but under-studied design aspect is the extent to which pay-for-performance schemes reflect local priorities. The English Department of Health White Paper High Quality Care for All introduced a Commissioning for Quality and Innovation (CQUIN) Framework from April 2009, under which local commissioners and providers were required to negotiate and implement an annual pay-for-performance scheme. In 2010/2011, these schemes covered 1.5% (￡l.0bn) of NHS expenditure. Local design was intended to offer flexibility to local priorities and generate local enthusiasm, while retaining good design properties of focusing on outcomes and processes with a clear link to quality, using established indicators where possible, and covering three key domains of quality (safety; effectiveness; patient experience) and innovation. We assess the extent to which local design achieved these objectives. Methods: Quantitative analysis of 337 locally negotiated CQUIN schemes in 2010/2011, along with qualitative analysis of 373 meetings (comprising 800 hours of observation) and 230 formal interviews (audio-recorded and transcribed verbatim) with NHS staff in 12 case study sites.Results: The local development process was successful in identifying variation in local needs and priorities for quality improvement but the involvement of frontline clinical staff was insufficient to generate local enthusiasm around the schemes. The schemes did not in general live up to the requirements set by the Department of Health to ensure that local schemes addressed the original objectives for the CQUIN framework.Conclusions: While there is clearly an important case for local strategic and clinical input into the design of pay-for-performance schemes, this should be kept separate from the technical design process, which involves defining indicators, agreeing thresholds, and setting prices. These tasks require expertise that is unlikely to exist in each locality. The CQUIN framework potentially offered an opportunity to learn how technical design influenced outcome but due to the high degree of local experimentation and little systematic collection of key variables, it is difficult to derive lessons from this unstructured experiment about the impact and importance of different technical design factors on the effectiveness of pay-for-performance. Balancing the policy goal of localism with the objective of improving patient outcomes leads us to conclude that a somewhat firmer national framework would be preferable to a fully locally designed framework.
机译：目标：人们越来越认识到按绩效付费计划的设计特征对于确定其影响非常重要。一个重要但未被充分研究的设计方面是按绩效付费计划在多大程度上反映了本地优先级。英国卫生部白皮书《全民优质护理》从2009年4月开始引入质量和创新委托（CQUIN）框架，要求地方专员和提供者协商并实施年度绩效绩效计划。在2010/2011年，这些计划覆盖了NHS支出的1.5％（约合10亿英镑）。本地设计旨在为本地优先事项提供灵活性，并产生本地热情，同时保留良好的设计属性，即专注于与质量有明确联系的结果和过程，并尽可能使用已建立的指标，并涵盖质量的三个关键领域（安全性;有效性） ;患者经验）和创新。我们评估本地设计达到这些目标的程度。方法：对2010/2011年本地协商的337个CQUIN计划进行定量分析，并对12个案例研究地点的NHS工作人员进行的373次会议（包括800小时的观察）和230次正式访谈（录音和逐字记录）进行定性分析。结果：本地开发过程成功地确定了本地需求和质量改进重点的变化，但是一线临床人员的参与不足以在计划周围产生本地热情。总体而言，这些计划没有达到卫生部设定的要求，以确保地方计划满足CQUIN框架的原始目标。结论：尽管显然有重要的案例需要地方战略和临床投入来设计CQUIN。按绩效付费计划，应与技术设计过程分开进行，后者涉及定义指标，商定阈值和确定价格。这些任务需要在每个地方都不太可能存在的专业知识。 CQUIN框架可能提供了一个机会来学习技术设计如何影响结果，但是由于高度的本地实验和很少系统收集关键变量，因此很难从这个非结构化的实验中学到关于不同技术设计的影响和重要性的课程绩效工资有效性的因素。在平衡地方主义的政策目标与改善患者预后的目标之间，我们得出的结论是，相对牢固的国家框架要比完全由本地设计的框架更为可取。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号