PDF(Pubmed)
Abstract：
To spur improvement in health-care service quality and quantity, performance-based financing (PBF) is an increasingly common policy tool, especially in low- and middle-income countries. This study examines how personnel diversity and affective bonds in primary care clinics affect their ability to improve care quality in PBF arrangements. Leveraging data from a large-scale matched PBF intervention in Tajikistan including 208 primary care clinics, we examined how measures of personnel diversity (position and tenure variety) and affective bonds (mutual support and group pride) were associated with changes in the level and variability of clinical knowledge (diagnostic accuracy of 878 clinical vignettes) and care processes (completion of checklist items in 2485 instances of direct observations). We interacted the explanatory variables with exposure to PBF in cluster-robust, linear regressions to assess how these explanatory variables moderated the PBF treatment\'s association with clinical knowledge and care process improvements. Providers and facilities with higher group pride exhibited higher care process improvement (greater checklist item completion and lower variability of items completed). Personnel diversity and mutual support showed little significant associations with the outcomes. Organizational features of clinics exposed to PBF may help explain variation in outcomes and warrant further research and intervention in practice to identify and test opportunities to leverage them. Group pride may strengthen clinics\' ability to improve care quality in PBF arrangements. Improving health-care facilities\' pride may be an affordable and effective way to enhance health-care organization adaptation.
摘要：
背景：为了促进医疗保健服务质量和数量的提高，基于绩效的融资(PBF)是一种越来越常见的政策工具，特别是在低收入和中等收入国家。这项研究探讨了初级保健诊所中的人员多样性和情感纽带如何影响他们在PBF安排中提高护理质量的能力。
方法：利用来自塔吉克斯坦的大规模匹配PBF干预措施的数据，包括208个初级保健诊所，我们研究了人员多样性(职位和任期多样性)和情感纽带(相互支持和团体自豪感)的测量与临床知识水平和变异性(878例临床观察的诊断准确性)和护理过程(2485例直接观察中检查表项目的完成情况)的变化之间的关系.我们以集群稳健的方式将解释变量与PBF的暴露进行交互，线性回归评估这些解释变量如何调节PBF治疗与临床知识和护理流程改善的关联。
结果：具有较高群体自豪感的提供者和机构表现出更高的护理过程改进（更多的检查表项目完成和更低的项目完成可变性）。人员多样性和相互支持与结果几乎没有显着关联。
结论：暴露于PBF的诊所的组织特征可能有助于解释结果的变化，并需要在实践中进行进一步的研究和干预，以识别和测试利用它们的机会。团体自豪感可能会增强诊所在PBF安排中提高护理质量的能力。改善医疗机构的自豪感可能是增强医疗机构适应性的一种负担得起的有效方法。
方法：利用来自塔吉克斯坦的大规模匹配PBF干预措施的数据，包括208个初级保健诊所，我们研究了人员多样性(职位和任期多样性)和情感纽带(相互支持和团体自豪感)的测量与临床知识水平和变异性(878例临床观察的诊断准确性)和护理过程(2485例直接观察中检查表项目的完成情况)的变化之间的关系.我们以集群稳健的方式将解释变量与PBF的暴露进行交互，线性回归评估这些解释变量如何调节PBF治疗与临床知识和护理流程改善的关联。
结果：具有较高群体自豪感的提供者和机构表现出更高的护理过程改进（更多的检查表项目完成和更低的项目完成可变性）。人员多样性和相互支持与结果几乎没有显着关联。
结论：暴露于PBF的诊所的组织特征可能有助于解释结果的变化，并需要在实践中进行进一步的研究和干预，以识别和测试利用它们的机会。团体自豪感可能会增强诊所在PBF安排中提高护理质量的能力。改善医疗机构的自豪感可能是增强医疗机构适应性的一种负担得起的有效方法。
