financial incentives

财政激励
  • 文章类型: Journal Article
    背景:尽管获得医疗保健的机会越来越多,在撒哈拉以南非洲的许多地区,5岁以下儿童的死亡率仍然很高。提高护理质量的干预措施主要集中在对医务人员的额外培训上,但总体上影响不大。我们将评估财政激励的季度提供者知识评估对遵守刚果儿童疾病综合管理(IMCI)协议的影响,刚果民主共和国。
    方法:在目前正在进行的卫生融资计划下接受基于结果的融资的总共1738家机构中,本研究选择了110个设施。在这些设施中为5岁以下儿童提供门诊服务的所有卫生保健工作者将被纳入研究。设施以相等的概率随机分配至对照和治疗。治疗机构将使用交互式小插曲接受季度医务人员知识评估。这些小插曲的表现将通过向设施支付财政奖金来奖励。2018年进行了卫生工作者知识基线调查。终点线评估计划于2021年下半年开始。感兴趣的主要结果是卫生工作者遵守儿童疾病综合管理(IMCI)指南。将通过直接观察医务人员与患者的互动来验证依从性。
    结论:据我们所知,这是第一项试验,评估将健康筹资与医护人员在知识评估中的表现联系起来是否可以提高对5岁以下病例管理方案的依从性。
    背景:ClinicalTrials.govNCT04634019。于2020年11月18日注册。
    BACKGROUND: Despite increasing access to health care, under-5 mortality remains high in many parts of Sub-Saharan Africa. Interventions to improve quality of care have mostly focused on additional training for medical staff, but generally shown little impact. We will assess the impact of financially incentivized quarterly provider knowledge assessment on compliance with Integrated Management of Childhood Illness (IMCI) protocols in Congo, DRC.
    METHODS: Out of a total of 1738 facilities currently receiving results-based financing under an ongoing health financing program, 110 facilities were chosen for this study. All health care workers providing outpatient services to children under age 5 in these facilities will be included in the study. Facilities were randomized with equal probability to control and treatment. Treatment facilities will receive quarterly medical staff knowledge assessments using interactive vignettes. Performance on these vignettes will be rewarded through financial bonus payments to facilities. A baseline survey of health worker knowledge was conducted in 2018. An endline assessment is scheduled to start in the second half of 2021. The primary outcome of interest is health worker compliance with Integrated Management of Childhood Illness (IMCI) guidelines. Compliance will be verified through direct observation of medical staff-patient interactions.
    CONCLUSIONS: This is to our knowledge the first trial assessing whether linking health financing to health care worker performance on knowledge assessments can increase compliance with under-5 case management protocols.
    BACKGROUND: ClinicalTrials.gov NCT04634019 . Registered on November 18, 2020.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Practice Guideline
    评估非药物干预促进戒烟的益处,产科和新生儿结局,为孕妇吸烟(PWS)提供最佳护理。
    我们搜索了Medline数据库,Cochrane图书馆并咨询了国际准则。
    涉及全球所有非药物干预措施的“咨询”对戒烟(NP1)有益,对出生体重和早产(NP2)有益。短暂干预似乎对戒烟(NP2)无效。动机性访谈的影响尚未在怀孕期间得到证实(NP2)。认知行为干预没有显示出优越性(NP2)。经济激励措施对戒烟有好处,也可能对新生儿结局(NP1)有好处。反馈干预(Co测试仪)提供异构结果(NP2)。自助干预(NP2)和健康教育(NP2)似乎对戒烟有效。在PWS中很少或没有研究催眠疗法和针灸。适度的身体活动对戒烟没有显着影响(NP2),但似乎可以减少对烟草的渴望(NP3)。
    我们建议向所有PWS询问他们的吸烟消费情况,并详细说明他们的吸烟史。根据他们的喜好为他们提供不同类型的咨询,并让他们参与多学科(A级)。不建议系统地使用反馈(C级),但经验表明,CO测试仪在建立治疗联盟(专业共识)方面很重要。建议使用自助干预措施(C级)和健康教育(B级)。
    To assess the benefit of non-pharmacological intervention promoting on smoking cessation, obstetric and neonatal outcomes, to offer pregnant women who smoke (PWS) optimal care.
    We searched Medline Database, Cochrane Library and consulted international guidelines.
    \"Counselling\" involving globally all kind of non-pharmacological interventions has a benefit on smoking cessation (NP1) and a moderate benefit on birth weight and prematurity (NP2). The brief intervention seems ineffective on smoking cessation (NP2). The effects of motivational interviewing have not been demonstrated during pregnancy (NP2). Cognitive-behavioral interventions do not show superiority (NP2). Financial incentives have a benefit for smoking cessation and possibly for neonatal outcomes (NP1). Feedback interventions (Co tester) provide heterogeneous results (NP2). Self-help interventions (NP2) and health education (NP2) seem effective on smoking cessation. Hypnotherapy and acupuncture have been little or not studied in PWS. Moderate physical activity did not show a significant effect (NP2) on smoking cessation but seem to reduce craving for tobacco (NP3).
    We recommend asking all PWS about their smoking consumption and detailing their smoking history, offering them different types of counselling according to their preferences and involving them multidisciplinary (grade A). The systematic use of feedback is not recommended (grade C) but experience suggests that the CO tester is important in establishing a therapeutic alliance (professional consensus). The use of self-help interventions (grade C) and health education (grade B) are recommended.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Sci-hub)

  • 文章类型: Journal Article
    BACKGROUND: We designed and implemented the Brigham and Women\'s Wellness Initiative (B-Well), a single-arm study to examine the feasibility of a workplace program that used individual and team-based financial incentives to increase physical activity among sedentary hospital employees.
    METHODS: We enrolled sedentary, non-clinician employees of a tertiary medical center who self-reported low physical activity. Eligible participants formed or joined teams of three members and wore Fitbit Flex activity monitors for two pre-intervention weeks followed by 24 weeks during which they could earn monetary rewards. Participants were rewarded for increasing their moderate-to-vigorous physical activity (MVPA) by 10% from the previous week or for meeting the Centers for Disease Control and Prevention (CDC) physical activity guidelines (150 min of MVPA per week). Our primary outcome was the proportion of participants meeting weekly MVPA goals and CDC physical activity guidelines. Secondary outcomes included Fitbit-wear adherence and factors associated with meeting CDC guidelines more consistently.
    RESULTS: B-Well included 292 hospital employees. Participants had a mean age of 38 years (SD 11), 83% were female, 38% were obese, and 62% were non-Hispanic White. Sixty-three percent of participants wore the Fitbit ≥4 days per week for ≥20 weeks. Two-thirds were satisfied with the B-Well program, with 79% indicating that they would participate again. Eighty-six percent met either their personal weekly goal or CDC physical activity guidelines for at least 6 out of 24 weeks, and 52% met their goals or CDC physical activity guidelines for at least 12 weeks. African Americans, non-obese subjects, and those with lower impulsivity scores reached CDC guidelines more consistently.
    CONCLUSIONS: Our data suggest that a financial incentives-based workplace wellness program can increase MVPA among sedentary employees. These results should be reproduced in a randomized controlled trial.
    BACKGROUND: Clinicaltrials.gov, NCT02850094 . Registered July 27, 2016 [retrospectively registered].
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Sci-hub)

公众号