Dataset Information

Relationship between physician financial incentives and clinical pathway compliance: a cross-sectional study of 18 public hospitals in China.

ABSTRACT:

Objectives

Many strategies have been either used or recommended to promote physician compliance with clinical practice guidelines and clinical pathways (CPs). This study examines the relationship between hospitals' use of financial incentives to encourage physician compliance with CPs and physician adherence to CPs.

Design

A retrospectively cross-sectional study of the relationship between the extent to which patient care was consistent with CPs and hospital's use of financial incentives to influence CP compliance.

Setting

Eighteen public hospitals in three provinces in China.

Participants

Stratified sample of 2521 patients discharged between 3 January 2013 and 31 December 2014.

Primary outcome measures

The proportion of key performance indicators (KPIs) met for patients with (1) community-acquired pneumonia (pneumonia), (2) acute myocardial infarction (AMI), (3) acute left ventricular failure (heart failure), (4) planned caesarean section (C-section) and (5) gallstones associated with acute cholecystitis and associated cholecystectomy (cholecystectomy).

Results

The average implementation rate of CPs for five conditions (pneumonia, AMI, heart failure, C-section and cholecystectomy) based on 2521 cases in 18 surveyed hospitals was 57% (ranging from 44% to 67%), and the overall average compliance rate for the KPIs for the five conditions was 69.48% (ranging from 65.07% to 77.36%). Implementation of CPs was associated with greater compliance within hospitals only when hospitals adopted financial incentives directed at physicians to promote compliance.

Conclusion

CPs are viewed as important strategies to improve medical care in China, but they have not been widely implemented or adhered to in Chinese public hospitals. In addition to supportive resources, education/training and better administration in general, hospitals should provide financial incentives to encourage physicians to adhere to CPs.

SUBMITTER: Bai J

PROVIDER: S-EPMC6549614 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Relationship between physician financial incentives and clinical pathway compliance: a cross-sectional study of 18 public hospitals in China.

Bai Jie J Bundorf Kate K Bai Fei F Tang Huiqin H Xue Di D

BMJ open 20190528 5

<h4>Objectives</h4>Many strategies have been either used or recommended to promote physician compliance with clinical practice guidelines and clinical pathways (CPs). This study examines the relationship between hospitals' use of financial incentives to encourage physician compliance with CPs and physician adherence to CPs.<h4>Design</h4>A retrospectively cross-sectional study of the relationship between the extent to which patient care was consistent with CPs and hospital's use of financial inc ...[more]

PMID: 31142531

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Project description:BackgroundWorkplace climate is a great significant element that has an impact on nurses' behavior and practice; moreover, nurses' service behavior contributes to the patients' satisfaction and subsequently to the long-term success of hospitals. Few studies explore how different types of organizational ethical climate encourage nurses to engage in both in-role and extra-role service behaviors, especially in comparing the influencing process between public and private hospitals. This study aimed to compare the relationship between the five types of ethical climate and nurses' in-role and extra-role service behaviors in public and private hospitals.MethodsThis study conducted a cross-sectional survey on 559 nurses from China in May 2019. The questionnaire was distributed to nurses by sending a web link via the mobile phone application WeChat through snowball sampling methods. All participants were investigated using the Ethical Climate Scale and Service Behavior Questionnaire. SPSS 22.0 was used for correlation analysis, t-test, and analysis of variance test, and Mplus 7.4 was used for group comparison (p < .05).ResultsThe law and code climate has a much greater influence on nurses' in-role service behavior in private hospitals than on that in public hospitals (β = - 0.277; CI 95 % = [-0.452, - 0.075]; p < .01), and the instrumental climate has a stronger influence on nurses' extra-role service behavior private hospitals than on that in public hospitals (β = - 0.352; CI 95 % = [-0.651, - 0.056]; p < .05). Meanwhile, the rules climate has a greater effect on nurses' extra-role service behavior in public hospitals than it does in private hospitals (β = 0.397; CI 95 % = [0.120, 0.651]; p < .01).ConclusionsAs the relationship between the five types of ethical climate and nurses' in-role and extra-role service behaviors in public and private hospitals were different, the strategies used to foster and enhance the types of ethical climate are various from public to private hospitals. The caring and instrumental climate are the key to promote extra-role service behavior for nurses in private hospitals. And the independent climate has a great effect on extra-role service behaviors for nurses in public hospitals.

Project description:The Internet hospital, an innovative approach to providing health care, is rapidly developing in China because it has the potential to provide widely accessible outpatient service delivery via Internet technologies. To date, China's Internet hospitals have not been systematically investigated.The aim of this study was to describe the characteristics of China's Internet hospitals, and to assess their health service capacity.We searched Baidu, the popular Chinese search engine, to identify Internet hospitals, using search terms such as "Internet hospital," "web hospital," or "cloud hospital." All Internet hospitals in mainland China were eligible for inclusion if they were officially registered. Our search was carried out until March 31, 2017.We identified 68 Internet hospitals, of which 43 have been put into use and 25 were under construction. Of the 43 established Internet hospitals, 13 (30%) were in the hospital informatization stage, 24 (56%) were in the Web ward stage, and 6 (14%) were in full Internet hospital stage. Patients accessed outpatient service delivery via website (74%, 32/43), app (42%, 18/43), or offline medical consultation facility (37%, 16/43) from the Internet hospital. Furthermore, 25 (58%) of the Internet hospitals asked doctors to deliver health services at a specific Web clinic, whereas 18 (42%) did not. The consulting methods included video chat (60%, 26/43), telephone (19%, 8/43), and graphic message (28%, 12/43); 13 (30%) Internet hospitals cannot be consulted online any more. Only 6 Internet hospitals were included in the coverage of health insurance. The median number of doctors available online was zero (interquartile range [IQR] 0 to 5; max 16,492). The median consultation fee per time was ¥20 (approximately US $2.90, IQR ¥0 to ¥200).Internet hospitals provide convenient outpatient service delivery. However, many of the Internet hospitals are not yet mature and are faced with various issues such as online doctor scarcity and the unavailability of health insurance coverage. China's Internet hospitals are heading in the right direction to improve provision of health services, but much more remains to be done.

Project description:Pay for performance is intended to align incentives to promote high-quality care, but results have been contradictory.To test the effect of explicit financial incentives to reward guideline-recommended hypertension care.Cluster randomized trial of 12 Veterans Affairs outpatient clinics with 5 performance periods and a 12-month washout that enrolled 83 primary care physicians and 42 nonphysician personnel (eg, nurses, pharmacists).Physician-level (individual) incentives, practice-level incentives, both, or none. Intervention participants received up to 5 payments every 4 months; all participants could access feedback reports.Among a random sample, number of patients achieving guideline-recommended blood pressure thresholds or receiving an appropriate response to uncontrolled blood pressure, number of patients prescribed guideline-recommended medications, and number who developed hypotension.Mean (SD) total payments over the study were $4270 ($459), $2672 ($153), and $1648 ($248) for the combined, individual, and practice-level interventions, respectively. The unadjusted baseline and final percentages and the adjusted absolute change over the study in patients meeting the combined blood pressure/appropriate response measure were 75% to 84% and 8.84% (95% CI, 4.20% to 11.80%) for the individual group, 80% to 85% and 3.70% (95% CI, 0.24% to 7.68%) for the practice-level group, 79% to 88% and 5.54% (95% CI, 1.92% to 9.52%) for the combined group, and 86% to 86% and 0.47% (95% CI, -3.12% to 4.04%) for the control group. The adjusted absolute estimated difference in the change between the proportion of patients with blood pressure control/appropriate response for individual incentive and control groups was 8.36% (95% CI, 2.40% to 13.00%; P=.005). The other incentive groups did not show a significant change compared with controls for this outcome. For medications, the unadjusted baseline and final percentages and the adjusted absolute change were 61% to 73% and 9.07% (95% CI, 4.52% to 13.44%), 56% to 65% and 4.98% (95% CI, 0.64% to 10.08%), 65% to 80% and 7.26% (95% CI, 2.92% to 12.48%), and 63% to 72% and 4.35% (95% CI, -0.28% to 9.28%), respectively. These changes in the use of guideline-recommended medications were not significant in any of the incentive groups compared with controls, nor was the incidence of hypotension. The effect of the incentive was not sustained after a washout.Individual financial incentives, but not practice-level or combined incentives, resulted in greater blood pressure control or appropriate response to uncontrolled blood pressure; none of the incentives resulted in greater use of guideline-recommended medications or increased incidence of hypotension compared with controls. Further research is needed on the factors that contributed to these findings.clinicaltrials.gov Identifier: NCT00302718.

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Dataset Information

Relationship between physician financial incentives and clinical pathway compliance: a cross-sectional study of 18 public hospitals in China.

Objectives

Design

Setting

Participants

Primary outcome measures

Results

Conclusion

Publications

Relationship between physician financial incentives and clinical pathway compliance: a cross-sectional study of 18 public hospitals in China.

Similar Datasets

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