Impact of pay-for-performance for stroke unit access on mortality in Queensland, Australia: an interrupted time series analysis

被引:3
作者
Grimley, Rohan S. [1 ,2 ,9 ,11 ]
Collyer, Taya A. [3 ]
Andrew, Nadine E. [4 ,5 ,9 ]
Dewey, Helen M. [6 ]
Horton, Eleanor S. [2 ,7 ]
Cadigan, Greg [8 ]
Cadilhac, Dominique A. [9 ,10 ]
机构
[1] Griffith Univ, Sch Med & Dent, Birtinya, Qld 4575, Australia
[2] Queensland Dept Hlth, State Wide Stroke Clin Network, Clin Excellence Queensland, Brisbane, Qld 4001, Australia
[3] Monash Univ, Peninsula Clin Sch Cent, Cent Clin Sch, Frankston, Vic 3199, Australia
[4] Monash Univ, Peninsula Clin Sch, Cent Clin Sch, Frankston, Vic 3199, Australia
[5] Monash Univ, Natl Ctr Hlth Ageing, Frankston, Vic 3199, Australia
[6] Monash Univ, Eastern Hlth Clin Sch, Box Hill, Vic 3128, Australia
[7] Univ Sunshine Coast, Maroochydore, Qld 4558, Australia
[8] Queensland Dept Hlth, Healthcare Improvement Unit, Clin Excellence Queensland, Brisbane, Qld 4001, Australia
[9] Monash Univ, Sch Clin Sci Monash Hlth, Dept Med, Stroke & Ageing Res, Clayton 3168, Australia
[10] Florey Inst Neurosci & Mental Hlth, Stroke Div, Parkville, Vic, Australia
[11] Sunshine Coast Univ Hosp, 6 Doherty St, Birtinya, Qld 4575, Australia
来源
LANCET REGIONAL HEALTH-EUROPE | 2023年 / 41卷
基金
英国医学研究理事会;
关键词
Pay-for-performance; Stroke; Myocardial infarction; Stroke unit; Mortality; Clinical improvement collaboratives; 1ST-EVER STROKE; IMPLEMENTATION; SURVIVAL; OUTCOMES; CARE;
D O I
10.1016/j.lanwpc.2023.100921
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background Stroke unit care provides substantial benefits for all subgroups of patient with stroke, but consistent access has been difficult to achieve in many healthcare systems. Pay-for-performance incentives have been introduced widely in attempt to improve quality and efficiency in healthcare, but there is limited evidence of positive impact when they are targeted at hospitals. In 2012, a pay-for-performance program targeting stroke unit access was co -designed and implemented within a clinical quality improvement network across public hospitals in Queensland, Australia. We assessed the impact on access to specialist care and mortality following stroke. Methods We used interrupted time series analysis on linked hospital and death registry data to compare changes in level (absolute proportions) and trends in outcomes (stroke/coronary care unit admission, 6-month mortality) for stroke, and a control condition of myocardial infarction (MI) without pay-for-performance incentive, from 2009 before, to 2017 after introduction of the pay-for-performance scheme in 2012. Findings We included 23,572 patients with stroke and 39,511 with MI. Following pay-for-performance introduction, stroke unit access increased by an absolute 35% (95% CI 29, 41) more than historical trend prediction, with greater impact for regional/rural residents (41% vs major city 24%) where baseline access was lowest (18% vs major city residents 53%). Historical upward 6-month mortality trends following stroke (+0.11%/month) reversed to a downward slope (-0.05%/month) with pay-for-performance; difference -0.16%/month (95% CI -0.29, -0.03). In contrast, access to coronary care and mortality trends for MI controls were unchanged, difference-in-difference for mortality -0.18%, (95% CI -0.34, -0.02). Interpretation This clinician led pay-for-performance incentive stimulated significant improvements in stroke unit access, reduced regional disparities; and resulted in a sustained decline in 6-month mortality. As our findings contrast with lack of effect in most hospital directed pay-for-performance programs, differences in design and context provide insights for optimal program design. Funding Queensland Advancing Clinical Research Fellowship, National Health and Medical Research Council Senior Research Fellowship. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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页数:10
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