Abstract:
OBJECTIVE:To evaluate the effect of financial incentives on four clinical quality indicators common to pay for performance plans in the United Kingdom and at Kaiser Permanente in California. DESIGN:Longitudinal analysis. SETTING:35 medical facilities of Kaiser Permanente Northern California, 1997-2007. PARTICIPANTS:2 523 659 adult members of Kaiser Permanente Northern California. Main outcomes measures Yearly assessment of patient level glycaemic control (HbA(1c) <8%), screening for diabetic retinopathy, control of hypertension (systolic blood pressure <140 mm Hg), and screening for cervical cancer. RESULTS:Incentives for two indicators-screening for diabetic retinopathy and for cervical cancer-were removed during the study period. During the five consecutive years when financial incentives were attached to screening for diabetic retinopathy (1999-2003), the rate rose from 84.9% to 88.1%. This was followed by four years without incentives when the rate fell year on year to 80.5%. During the two initial years when financial incentives were attached to cervical cancer screening (1999-2000), the screening rate rose slightly, from 77.4% to 78.0%. During the next five years when financial incentives were removed, screening rates fell year on year to 74.3%. Incentives were then reattached for two years (2006-7) and screening rates began to increase. Across the 35 facilities, the removal of incentives was associated with a decrease in performance of about 3% per year on average for screening for diabetic retinopathy and about 1.6% per year for cervical cancer screening. CONCLUSION:Policy makers and clinicians should be aware that removing facility directed financial incentives from clinical indicators may mean that performance levels decline.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Lester H,Schmittdiel J,Selby J,Fireman B,Campbell S,Lee J,Whippy A,Madvig Pdoi
10.1136/bmj.c1898subject
Has Abstractpub_date
2010-05-11 00:00:00pages
c1898eissn
0959-8138issn
1756-1833journal_volume
340pub_type
杂志文章,多中心研究abstract:OBJECTIVE:To identify additional factors, such as maternal age or factors related to previous reproductive outcome or family history, and the corresponding probability of carrying a chromosome abnormality in couples with two or more miscarriages. DESIGN:Nested case-control study. SETTING:Six centres for clinical gene...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.38498.669595.8F
更新日期:2005-07-16 00:00:00
abstract::Recent changes in the Russian government introduced by Boris Yeltsin include the appointment of Eduard Nechaev as health minister at the beginning of this year. The appointment received little publicity in the West, although his predecessor was sacked after only one year for failing to make any effort to improve healt...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6882.909
更新日期:1993-04-03 00:00:00
abstract::Objectives To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21st birth weight standard.Design Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestatio...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.j3677
更新日期:2017-08-17 00:00:00
abstract:OBJECTIVES:To examine trends over time in the rates of admission to hospital for accidents of preschool children and to study patterns of repeated admissions for accidents in these children. DESIGN:Analysis of linked, routine abstracts of hospital inpatient records for accidents. SETTING:Six districts in the Oxford R...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.302.6767.16
更新日期:1991-01-05 00:00:00
abstract:OBJECTIVE:To assess evidence from randomised clinical trials about the effectiveness of extracts of Boswellia serrata (frankincense). DESIGN:Systematic review. DATA SOURCES:Electronic searches on Medline, Embase, Cinahl, Amed, and Cochrane Library. Hand searches of conference proceedings, bibliographies, and departme...
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pub_type: 杂志文章,评审
doi:10.1136/bmj.a2813
更新日期:2008-12-17 00:00:00
abstract::Prediction models are developed to aid health care providers in estimating the probability or risk that a specific disease or condition is present (diagnostic models) or that a specific event will occur in the future (prognostic models), to inform their decision making. However, the overwhelming evidence shows that th...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.g7594
更新日期:2015-01-07 00:00:00
abstract:OBJECTIVE:To determine whether the author's 20.9 lb (9.5 kg) carbon frame bicycle reduced commuting time compared with his 29.75 lb (13.5 kg) steel frame bicycle. DESIGN:Randomised trial. SETTING:Sheffield and Chesterfield, United Kingdom, between mid-January 2010 and mid-July 2010. PARTICIPANTS:One consultant in an...
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pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.c6801
更新日期:2010-12-09 00:00:00
abstract:OBJECTIVE:To determine whether abnormal results for liver function tests are investigated in primary care and findings on full investigation. DESIGN:Retrospective audit and prospective clinical investigation. SETTING:University hospital and surrounding general practices serving around 330 000 people. SUBJECTS:Adults...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.322.7281.276
更新日期:2001-02-03 00:00:00
abstract:UNLABELLED:OBJECTIVE--To measure needs for care of patients aged 18-65 years with major mental illness. DESIGN:Identification of everyone in one area seen by a health professional within the previous five years because of a psychotic disorder. Interview of a one in three sample of patients and their main carers with t...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.312.7046.1582
更新日期:1996-06-22 00:00:00
abstract:OBJECTIVE:To compare patient outcomes of restrictive versus liberal blood transfusion strategies in patients with cardiovascular disease not undergoing cardiac surgery. DESIGN:Systematic review and meta-analysis. DATA SOURCES:Randomised controlled trials involving a threshold for red blood cell transfusion in hospita...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.i1351
更新日期:2016-03-29 00:00:00
abstract:OBJECTIVE:To investigate estimation of calorie (energy) content of meals from fast food restaurants in adults, adolescents, and school age children. DESIGN:Cross sectional study of repeated visits to fast food restaurant chains. SETTING:89 fast food restaurants in four cities in New England, United States: McDonald's...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.f2907
更新日期:2013-05-23 00:00:00
abstract:OBJECTIVE:To evaluate the immunogenicity and reactogenicity of a new triple S recombinant hepatitis B vaccine in a cohort of healthy people in whom currently licensed hepatitis B vaccines had persistently not induced an immune response. DESIGN:Single centre, randomised, double blind, dose-response study. SETTING:Rese...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.314.7077.329
更新日期:1997-02-01 00:00:00
abstract::Currently, clinicians have to make decisions about how to manage pulmonary embolism on the basis of imperfect tests and assessment of odds. Management protocols that inevitably result in large numbers of patients being referred for angiography are unhelpful. Management decisions based on assessment of odds and investi...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.314.7078.425
更新日期:1997-02-08 00:00:00
abstract:OBJECTIVES:To provide a contemporary account of the treatment and outcomes of acute coronary attacks in England and Wales and to identify strategies that might improve the outcome. DESIGN:Two year community and hospital based study in three British health districts. SETTING:Health districts of Brighton (population 28...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:
更新日期:1998-04-04 00:00:00
abstract:OBJECTIVE:To assess the ability of ultrasonography to identify reflux nephropathy in children after urinary tract infection. DESIGN:Ten experienced radiologists performed a total of 240 ultrasonographic examinations of kidneys in a one day study. The examiners were unaware of the results of previous radiological and c...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.309.6949.235
更新日期:1994-07-23 00:00:00
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journal_title:BMJ (Clinical research ed.)
pub_type: 历史文章,杂志文章
doi:10.1136/bmj.311.7021.1708
更新日期:1995-12-23 00:00:00
abstract:OBJECTIVES:To determine the clinical and radiological features of severe acute respiratory syndrome (SARS) and to evaluate the accuracy of the World Health Organization's guidelines on defining cases of SARS. DESIGN:Prospective observational study. SETTING:A newly set up SARS screening clinic in the emergency departm...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.326.7403.1354
更新日期:2003-06-21 00:00:00
abstract:OBJECTIVES:To determine the accuracy of diagnoses of schizophrenia and non-affective psychosis entered by general practitioners on a computer system. To compare recording of clinical events on computer with written records. DESIGN:Examination of case notes of all patients with a computer diagnosis of psychosis. Search...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.307.6895.32
更新日期:1993-07-03 00:00:00
abstract:OBJECTIVE:To evaluate the impact of the revised diagnostic criteria for diabetes mellitus adopted by the American Diabetes Association on prevalence of diabetes and on classification of patients. For epidemiological purposes the American criteria use a fasting plasma glucose concentration >=7.0 mmol/l in contrast with ...
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pub_type: 杂志文章
doi:10.1136/bmj.317.7155.371
更新日期:1998-08-08 00:00:00
abstract::The author is one of the medical advisers to the judge who led a government inquiry into allegations that an experimental research program at the National Women's Hospital in Auckland, New Zealand, to study the natural course of cervical carcinoma in situ had withheld conventional treatment from some patients. She ar...
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pub_type: 杂志文章
doi:10.1136/bmj.297.6647.533
更新日期:1988-08-20 00:00:00
abstract::The Health of the Nation white paper set a target for 15% reduction in overall suicide rates by the year 2000. If the targets are to be achieved interventions must be identified which are of proved effectiveness. This paper examines the evidence on the available interventions and points of access to the population at ...
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pub_type: 杂志文章,评审
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更新日期:1994-05-07 00:00:00
abstract:OBJECTIVES:To determine the prevalence of antibodies to hepatitis B core antigen, hepatitis C virus, and HIV in entrants to Irish prisons and to examine risk factors for infection. DESIGN:Cross sectional, anonymous survey, with self completed risk factor questionnaire and oral fluid specimen for antibody testing. SET...
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pub_type: 杂志文章
doi:10.1136/bmj.323.7323.1209
更新日期:2001-11-24 00:00:00
abstract:OBJECTIVE:To determine the relative importance of appropriate prescribing for asthma in explaining high rates of hospital admission for asthma among east London general practices. DESIGN:Poisson regression analysis describing relation of each general practice's admission rates for asthma with prescribing for asthma an...
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pub_type: 杂志文章
doi:10.1136/bmj.314.7079.482
更新日期:1997-02-15 00:00:00
abstract:OBJECTIVE:To assess relative efficacy and toxicity of aminoglycosides given by single daily dose compared with multiple daily doses. DESIGN:Meta-analysis of 21 randomised trials identified through MEDLARS (1966 to January 1995). Data were overviewed with fixed effects and random effects models and with meta-regression...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
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更新日期:1996-02-10 00:00:00
abstract:OBJECTIVE:To see whether the issue of AIDS has influenced the observed decline in blood donation in Scotland. DESIGN:Two methods: a quantitative survey using personal interviews based on a questionnaire and a qualitative survey based on group discussions. SETTING:Interviews based on the questionnaire were conducted i...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.298.6679.1012
更新日期:1989-04-15 00:00:00
abstract:OBJECTIVE:To evaluate the association between consumption of ultra-processed foods and all cause mortality. DESIGN:Prospective cohort study. SETTING:Seguimiento Universidad de Navarra (SUN) cohort of university graduates, Spain 1999-2018. PARTICIPANTS:19 899 participants (12 113 women and 7786 men) aged 20-91 years ...
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pub_type: 杂志文章
doi:10.1136/bmj.l1949
更新日期:2019-05-29 00:00:00
abstract:OBJECTIVES:To assess heat related mortalities in relation to climate within Europe. DESIGN:Observational population study. SETTING:North Finland, south Finland, Baden-Württemberg, Netherlands, London, north Italy, and Athens. SUBJECTS:People aged 65-74. MAIN OUTCOME MEASURES:Mortalities at temperatures above, below...
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pub_type: 杂志文章
doi:10.1136/bmj.321.7262.670
更新日期:2000-09-16 00:00:00
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更新日期:2012-07-18 00:00:00
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pub_type: 杂志文章
doi:10.1136/bmj.302.6770.207
更新日期:1991-01-26 00:00:00
abstract:OBJECTIVE:To study the effects on children of humanitarian aid agencies restricting help to refugee families (internally displaced people). DESIGN:Follow up study of 3 months. SETTING:Prabis peninsular outside Bissau, the capital of Guinea-Bissau, which has functioned as a refugee area for internally displaced people...
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pub_type: 杂志文章
doi:10.1136/bmj.319.7214.878
更新日期:1999-10-02 00:00:00