按绩效支付对全科医生影响的系统评价

Pay-for-performance for primary care physicians:a systematic review

目的系统评价国内外按绩效支付对全科医生的影响。方法计算机检索The Cochrane Library、Database of Abstracts of Reviews of Effects、EMbase、Web of Science、PubMed、Dissertations and Theses Database、EconLit、CNKI、WanFang Data、IDEAS和POPLINE数据库,搜集关于按绩效支付对全科医生影响的研究,检索时限均为建库至2021年5月。由2名研究者独立筛选文献、提取数据并评价纳入研究的偏倚风险后,采用Rev Man 5.4软件进行分析。结果共纳入10个研究。Meta分析结果显示,在现有支付方式基础上引入按绩效支付后,可能会改善医疗补助计划中3~35月龄的儿童免疫接种状况[RR=1.27,95%CI(1.19,1.36),P<0.001]、增加高血压患者的指南推荐降压药处方数量[RR=1.07,95%CI(1.02,1.12),P=0.006]、改善服务提供和患者健康结果的混合效果[RR=1.13,95%CI(1.04,1.23),P=0.004]。结论现有证据表明,按绩效支付可能会增加全科医生提供的服务数量、改善目标人群的服务质量,但对个体患者健康结果的影响尚不明确。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the efficacy of pay-for-performance(P4 P) for primary care physicians(PCPs). Methods The Cochrane Library, Database of Abstracts of Reviews of Effects, EMbase, Web of Science, PubMed, Dissertations and Theses Database, EconLit, CNKI, WanFang Data, IDEAS, and POPLINE were searched to collect studies on the efficacy of P4 P for PCPs from inception to May 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Statistical analysis was then performed by using RevMan 5.4 software. Results A total of 10 studies were included. The results of meta-analysis showed that P4 P incentives possibly improved child immunization status(RR=1.27, 95%CI 1.19 to 1.36, P<0.001), slightly improved primary care physicians’ prescribing of guideline-recommended antihypertensive medicines compared with existing payment method(RR=1.07, 95%CI 1.02 to 1.12, P=0.006), and improved a mixed outcome measure of service provision and patient health outcomes(RR=1.13, 95%CI 1.04 to 1.23, P=0.004). Conclusions Current evidence shows that P4 P possibly increases the quantity of health service provision and improve quality of service provision for targeted populations. The effects of P4 P on health outcomes is uncertain. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.