PDF(Pubmed)
Abstract：
BACKGROUND: Healthcare regulators in many countries undertake inspections of healthcare providers and publish inspection outcomes with the intention of improving quality of care. Comprehensive inspections of general practices in England by the Care Quality Commission began for the first time in 2014. It is assumed that inspection and rating will raise standards and improve care, but the presence and extent of any improvements is unknown. We aim to determine if practice inspection ratings are associated with past performance on prescribing indicators and if prescribing behaviour changes following inspection.
METHODS: Longitudinal study using a dataset of 6771 general practices in England. Practice inspection date and score was linked with monthly practice-level data on prescribing indicators relating to antibiotics, hypnotics and non-steroidal anti-inflammatory drugs. The sample covers practices receiving their first inspection between September 2014 and December 2018. Regression analysis and the differential timing of inspections is used to identify the impact on prescribing.
RESULTS: Better-rated practices had better prescribing in the period before inspections began. In the six months following inspections, no overall change in prescribing was observed. However, the differences between the best and worse rated practices were reduced but not fully. The same is also true when taking a longer-term view. There is little evidence that practices responded in anticipation of inspection or reacted differently once the ratings were made public.
CONCLUSIONS: While some of the observed historic variation in prescribing behaviour has been lessened by the process of inspection and ratings, we find this change is small and appears to come from both improvements among lower-rated practices and deteriorations among higher-rated practices. While inspection and rating no doubt had other impacts, these prescribing indicators were largely unchanged.
METHODS: Longitudinal study using a dataset of 6771 general practices in England. Practice inspection date and score was linked with monthly practice-level data on prescribing indicators relating to antibiotics, hypnotics and non-steroidal anti-inflammatory drugs. The sample covers practices receiving their first inspection between September 2014 and December 2018. Regression analysis and the differential timing of inspections is used to identify the impact on prescribing.
RESULTS: Better-rated practices had better prescribing in the period before inspections began. In the six months following inspections, no overall change in prescribing was observed. However, the differences between the best and worse rated practices were reduced but not fully. The same is also true when taking a longer-term view. There is little evidence that practices responded in anticipation of inspection or reacted differently once the ratings were made public.
CONCLUSIONS: While some of the observed historic variation in prescribing behaviour has been lessened by the process of inspection and ratings, we find this change is small and appears to come from both improvements among lower-rated practices and deteriorations among higher-rated practices. While inspection and rating no doubt had other impacts, these prescribing indicators were largely unchanged.
摘要：
背景：许多国家的医疗保健监管机构对医疗保健提供者进行检查并公布检查结果，旨在提高护理质量。2014年，医疗质量委员会首次开始对英格兰的一般做法进行全面检查。假定检查和评级将提高标准并改善护理，但任何改善的存在和程度是未知的。我们的目标是确定实践检查评级是否与处方指标的过去表现相关，以及检查后处方行为是否发生变化。
方法：使用英格兰6771个一般实践的数据集进行纵向研究。实践检查日期和得分与每月关于抗生素处方指标的实践水平数据挂钩，催眠药和非甾体抗炎药。该样本涵盖2014年9月至2018年12月期间接受首次检查的实践。使用回归分析和检查的差异时间来确定对处方的影响。
结果：在检查开始之前，评级较高的实践具有更好的处方。在检查后的六个月里，未观察到处方的总体变化.然而,最佳和较差评级做法之间的差异有所减少，但并不完全。从长远来看也是如此。几乎没有证据表明，一旦评级公开，实践对检查的预期做出了反应，或者做出了不同的反应。
结论：虽然观察到的处方行为的一些历史变化由于检查和评级过程而有所减少，我们发现这种变化很小，似乎来自评级较低的做法的改善和评级较高的做法的恶化。虽然检查和评级无疑会产生其他影响，这些处方指标基本没有变化.
方法：使用英格兰6771个一般实践的数据集进行纵向研究。实践检查日期和得分与每月关于抗生素处方指标的实践水平数据挂钩，催眠药和非甾体抗炎药。该样本涵盖2014年9月至2018年12月期间接受首次检查的实践。使用回归分析和检查的差异时间来确定对处方的影响。
结果：在检查开始之前，评级较高的实践具有更好的处方。在检查后的六个月里，未观察到处方的总体变化.然而,最佳和较差评级做法之间的差异有所减少，但并不完全。从长远来看也是如此。几乎没有证据表明，一旦评级公开，实践对检查的预期做出了反应，或者做出了不同的反应。
结论：虽然观察到的处方行为的一些历史变化由于检查和评级过程而有所减少，我们发现这种变化很小，似乎来自评级较低的做法的改善和评级较高的做法的恶化。虽然检查和评级无疑会产生其他影响，这些处方指标基本没有变化.
