Effect of UK Quality and Outcomes Framework pay-for-performance programme on quality of primary care: systematic review with quantitative synthesis.

Methods

Systematic reviewwith quantitative synthesis.

系统性综述与定量合成。

data_sources

MEDLINE, Embase, CINAHL, PsycINFO, and Scopus databases were searched from 1 January 2004 to 3 September 2024.

从2004年1月1日至2024年9月3日，对MEDLINE、Embase、CINAHL、PsycINFO和Scopus数据库进行了检索。

study_selection

Eligible studies used repeated cross sectional or cohort designs with consistent measurement before and after incentive introduction or withdrawal. Studies with a minimum of three time points before and after intervention were included in quantitative synthesis.

符合条件的研究使用了重复的横断面或队列设计，在激励措施引入或撤销前后进行了持续的测量。在干预措施前后至少有三个时间点的研究被纳入定量综合分析。

data_extraction

Analysis used both reported impact if available and de novo interrupted time series analysis of extracted raw data if not reported by the original study.

分析既使用了原始研究中报告的影响（如果有的话），也使用了如果原始研究没有报告，则对提取的原始数据进行的新的中断时间序列分析。

data_synthesis

Meta-analysiswas not appropriate; findings were quantitatively synthesised by reporting medians and interquartile ranges of changes in quality or reported narratively.

元分析不适用；通过报告质量变化的中位数和四分位数范围，或以叙述性方式报告，定量综合了研究结果。

Risk of bias was assessed using the Mixed Methods Assessment Tool.

使用混合方法评估工具评估了偏倚风险。

Results

30 studies were included, with 11 providing data for quantitative synthesis.

共有30项研究被纳入，其中11项提供了定量综合的数据。

Across all indicators, evidence was found of improvement in recorded quality at one year after incentive introduction (83 indicators; median change compared with that predicted by pre-incentivisation trends 6.1 (interquartile range (IQR) 1.9 to 14.6) percentage points) but less consistently at three years (72 indicators; median change 0.7 (-2.1 to 8.9) percentage points).

在所有指标中，发现引入激励措施一年后记录的质量有所改善（83个指标；与激励前趋势预测的中位数变化为6.1（四分位数间距（IQR）1.9至14.6）个百分点），但在三年后的一致性较差（72个指标；中位数变化为0.7（-2.1至8.9）个百分点）。

Impact was higher for process indicators with lower performance in the year before incentivisation.

对于激励前一年表现较低的过程指标，激励措施的影响更大。

Incentive withdrawal was associated with reduction in recorded quality compared with predicted at both one year (31 indicators; median change -10.7 (IQR -17.9 to -3.8) percentage points) and three years (31 indicators; median change -12.8 (-21.0 to -4.4) percentage points).

激励措施的撤销与记录质量的降低相关，与预测值相比，在一年时（31个指标；中位数变化-10.7（四分位数间距-17.9至-3.8）百分点）和三年时（31个指标；中位数变化-12.8（四分位数间距-21.0至-4.4）百分点）都有所体现。

The largest changes with both incentive introduction and withdrawal were for complex process indicators such as diabetes foot screening, with smaller changes in simple processes such as blood pressure measurement, intermediate outcomes, and treatment indicators.

无论是引入还是撤销激励措施，对于复杂流程指标（如糖尿病足筛查）的变化最大，而对于简单流程（如血压测量）、中间结果和治疗指标的变化较小。

For all types of indicators, the reduction in quality following incentive withdrawal generally matched or exceeded the gains observed after incentive introduction (for example, for 14 indicators with data for both, median change at three years for incentive introduction was a 1.4 (IQR -0.9 to 4.6) percentage point increase versus a 3.9 (IQR 2.2 to 11.6) decrease for incentive withdrawal).

对于所有类型的指标，激励措施撤销后质量的下降通常与激励措施引入后观察到的改善相匹配或超过（例如，对于14个有数据的指标，三年内激励措施引入的中位数变化是1.4（四分位数间距-0.9至4.6）百分点的增加，而激励措施撤销的中位数变化是3.9（四分位数间距2.2至11.6）的减少）。

Conclusions

Quality and Outcomes Framework incentives consistently improved quality of care at one year beyond that predicted by pre-incentivisation trends, but by three years the impact was inconsistent and not clearly better than trend.

质量与结果框架激励措施一致地在一年内改善了护理质量，超出了激励措施引入前的趋势预测，但到了三年时，其影响不一致，且并不明显优于趋势。

Gains from incentivisation seemed to reverse after incentive withdrawal.

激励措施带来的收益在激励措施撤销后似乎发生了逆转。

study_registration

Prospero CRD42023467627.

Prospero CRD42023467627。