The impact of pay-for-performance on the quality of care in ophthalmology: Empirical evidence from Germany

Impacts of the diagnosis-intervention packet reform on costs and healthcare resource utilization: evidence from Guangzhou, China

BACKGROUND

The diagnosis-intervention packet (DIP) payment reform, utilizing big data for patient classification and payment standardization, was initially developed and piloted in China. Guangzhou, the pilot mega-city, rolled out DIP payment reform in 2018 to regulate medical expenditures. We estimated the impacts of DIP on costs and healthcare resource utilization in Guangzhou using a nine-year panel data set of Guangzhou and other regions between 2018 and 2020.

METHODS

By employing the synthetic difference-in-difference (SDID) method, we captured changes in outcome variables before and after DIP implementation in Guangzhou and non-reforming regions.

RESULTS

DIP payment reform increased per-episode inpatient costs by CNY 1574.735 (95% CI: 148.330 to 3001.140, P < 0.05), CNY 1583.413 (95% CI: 247.356 to 2919.470, P < 0.05), and CNY 1448.065 (95% CI: -132.051 to 3028.181.140, P < 0.1) among all hospitals, public hospitals, and private hospitals, respectively. In contrast, DIP had little effect on the average length of stay (LOS) among all hospitals from 2018 to 2020. Although DIP did not impact in-hospital mortality (IHM) overall, it increased IHM by 0.330 percentage points (95% CI: 0.008 to 0.652, P < 0.05) and 0.311 percentage points (95% CI: 0.158 to 0.463, P < 0.01) among private hospitals and secondary hospitals.

CONCLUSIONS

Our results suggest that the effects of DIP payment reform were mixed. While it did increase healthcare costs, its impacts on quality and operation efficiency varied significantly across different types of hospitals.

Ophthalmologists' Perspective on Barriers to Cataract Surgery and Surgical Productivity in Ethiopia, Ghana, and Zambia: A Descriptive, Mixed-Methods Survey

PURPOSE

While progress was made towards the Vision 2020: The Right to Sight goals, Ethiopia, Ghana, and Zambia fell short of the recommended cataract surgical rate (CSR) on a national level. Post-operative cataract surgical outcomes are also lower compared to other regions. This study aimed to describe perceived barriers to cataract surgical uptake, factors related to surgeon surgical productivity, and surgical offerings in each of these countries.

METHODS

An online survey was sent to ophthalmologists practicing in Ethiopia, Ghana, and Zambia. Responses were collected between June 25, 2021 and January 30, 2022.

RESULTS

Responses were received from 122 ophthalmologists from Ethiopia, Ghana, and Zambia. The estimated participation rate was 47% (122/257). Distance to cataract surgical centres, lack of surgical centres, and lack of surgical equipment were among the top 10 most agreed upon barriers by respondents within each country. Many respondents reported that current financial reimbursement does not incentivise maximum productivity in themselves (56%, 68/122) or their staff (61%, 74/122). Surgeons proposed several ways to improve productivity incentives. Private practice was perceived to have the best reimbursement incentives (77%, 94/122), whereas government hospitals were least agreed upon (4%, 5/122). Discrepancies in timely post-operative refraction and eyeglasses disbursement were reported.

CONCLUSIONS

Overcoming the identified barriers, improving surgeon productivity, and addressing identified deficits in cataract care will likely reduce the backlog of cataract blindness while ensuring increasingly improved patient outcomes.

Evaluating the Effectiveness of a Local Primary Care Incentive Scheme: A Difference-in-Differences Study

National financial incentive schemes for improving the quality of primary care have come under criticism in the United Kingdom, leading to calls for localized alternatives. This study investigated whether a local general practice incentive-based quality improvement scheme launched in 2011 in a city in the North West of England was associated with a reduction in all-cause emergency hospital admissions. Difference-in-differences analysis was used to compare the change in emergency admission rates in the intervention city, to the change in a matched comparison population. Emergency admissions rates fell by 19 per 1,000 people in the years following the intervention (95% confidence interval [17, 21]) in the intervention city, relative to the comparison population. This effect was greater among more disadvantaged populations, narrowing socioeconomic inequalities in emergency admissions. The findings suggest that similar approaches could be an effective component of strategies to reduce unplanned hospital admissions elsewhere.

Does an alignment of employment policies and individual preferences affect intention to stay in the profession? Evidence from Canadian Midwives

BACKGROUND

This study examines whether alignment of actual and preferred employment policies, including compensation method, employment status, and work schedule, affect midwives' intention to stay in the profession. The study further investigates the moderating effect of financial-rewards satisfaction and compares midwives' policy preferences in urban/rural practices.

METHODS

Cross-sectional survey data from 549 midwives across Canada were analysed through descriptive statistics, bivariate correlations, and hierarchical linear regressions. Further regression analysis separated data for urban/rural practicing midwives.

RESULTS

Three-quarters of the respondents are paid through a billable-course-of-care, while only one-third prefer this model. Another one-third prefer a combination of salary and billable-course-of-care. More than three-quarters of the respondents are independent contractors, but half prefer other forms of employee status. Lastly, half prefer a part-time work schedule, while others prefer full-time. Alignment of actual and preferred employment policies significantly explains midwives' intention to stay in the profession. Intentions to stay in the profession for urban midwives is significantly affected by the alignment of actual and preferred compensation methods, but not for rural ones. Both urban and rural midwives report similar preferences for employment status and work schedule policies. Furthermore, satisfaction with financial rewards is significantly associated with their intention to stay.

CONCLUSION

Policymakers can positively influence midwives' intention to stay in the profession by facilitating alignment of their actual and preferred employment policies.

Use of interrupted time series methods in the evaluation of health system quality improvement interventions: a methodological systematic review

BACKGROUND

When randomisation is not possible, interrupted time series (ITS) design has increasingly been advocated as a more robust design to evaluating health system quality improvement (QI) interventions given its ability to control for common biases in healthcare QI. However, there is a potential risk of producing misleading results when this rather robust design is not used appropriately. We performed a methodological systematic review of the literature to investigate the extent to which the use of ITS has followed best practice standards and recommendations in the evaluation of QI interventions.

METHODS

We searched multiple databases from inception to June 2018 to identify QI intervention studies that were evaluated using ITS. There was no restriction on date, language and participants. Data were synthesised narratively using appropriate descriptive statistics. The risk of bias for ITS studies was assessed using the Cochrane Effective Practice and Organisation of Care standard criteria. The systematic review protocol was registered in PROSPERO (registration number: CRD42018094427).

RESULTS

Of 4061 potential studies and 2028 unique records screened for inclusion, 120 eligible studies assessed eight QI strategies and were from 25 countries. Most studies were published since 2010 (86.7%), reported data using monthly interval (71.4%), used ITS without a control (81%) and modelled data using segmented regression (62.5%). Autocorrelation was considered in 55% of studies, seasonality in 20.8% and non-stationarity in 8.3%. Only 49.2% of studies specified the ITS impact model. The risk of bias was high or very high in 72.5% of included studies and did not change significantly over time.

CONCLUSIONS

The use of ITS in the evaluation of health system QI interventions has increased considerably over the past decade. However, variations in methodological considerations and reporting of ITS in QI remain a concern, warranting a need to develop and reinforce formal reporting guidelines to improve its application in the evaluation of health system QI interventions.