Incentives

激励机制
  • 文章类型: Journal Article
    背景:由于精神兴奋剂在美国药物中毒危机中的作用越来越大,越来越需要对兴奋剂使用障碍(StimUD)患者实施有效的循证治疗.应急管理是一种行为策略,具有支持StimUD治疗的有力证据。2023年,加利福尼亚州发起了一项大规模的努力,将CM作为兴奋剂使用障碍患者的治疗方法(可卡因,甲基苯丙胺,安非他明)称为恢复激励计划:加利福尼亚州的应急管理福利。
    方法:正在使用Beck等人系统地实施恢复激励计划。科学到服务实验室(SSL)的实施方法,并为此项目提供了多个增强功能。SSL具有三个核心组件:教学培训,性能反馈,和外部便利。在CM服务启动之前,我们通过对站点的就绪性评估流程来增强这种方法,以及发布后的持续保真度监视和反馈组件。
    结果:本文是一份初步报告,描述了在大规模实施工作中使用这种增强的SSL策略来实现CM。提供的数据描述了恢复激励计划前十个月的实施活动。
    结论:加州康复激励计划已经得到了系统的实施,并且似乎得到了治疗计划工作人员和注册成员的积极回应。未来的论文和评估报告将继续记录成员对该计划的回应,并报告正在进行的培训和实施过程。
    BACKGROUND: Due to the increasing role of psychostimulants in the US drug poisoning crisis, there is an increasing need to effectively implement evidence-based treatment for individuals with stimulant use disorder (StimUD). Contingency management is a behavioral strategy with robust evidence of support for the treatment of StimUD. In 2023, California initiated a large-scale effort to implement CM as a treatment for individuals with a stimulant use disorder (cocaine, methamphetamine, amphetamine) called the Recovery Incentives Program: California\'s Contingency Management Benefit.
    METHODS: The Recovery Incentives Program is being systematically implemented using the Becker et al. Science to Service Lab (SSL) implementation approach with several augmentations for this project. The SSL features three core components: didactic training, performance feedback, and external facilitation. We have augmented this approach with a readiness assessment process for sites prior to CM service launch, and an ongoing fidelity monitoring and feedback component post-launch.
    RESULTS: The present paper is a preliminary report describing the use of this augmented SSL strategy for CM implementation in a large-scale implementation effort. Data are presented to describe the implementation activities during the first ten months of the Recovery Incentives Program.
    CONCLUSIONS: The California Recovery Incentives Program has been systematically implemented and appears to be receiving a positive response from treatment program staff and enrolled members. Future papers and evaluation reports will continue to document member response to the Program and report on the ongoing training and implementation process.
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  • 文章类型: Journal Article
    目的:本研究旨在评估横滨步行点计划,这促进了关于步数和激励措施的反馈,以及健康预期寿命的延长。
    方法:本研究纳入了4298名年龄在65岁以上、对2013年和2016年的调查做出回应且在2016年未被证明需要长期护理的个体。参与者被归类为“不参与,\"\"参与不上传,\"和\"参与上传\"组基于他们的参与和上传的计步器数据。客观变量是长期护理认证的发生和随后四年的死亡。采用改进的泊松回归模型,在项目启动前调整15个变量。
    结果:共有440名参与者(10.2%)被纳入“参与上传”组,共有206名参与者(4.8%)被纳入“未上传参与”组。与“不参与”相比,“参与上传”的风险比为0.77(95%置信区间(CI):0.59-0.99),“参与不上传”的风险比为1.02(95%CI:0.75-1.38)。在敏感性分析中,将死亡作为不适用的结果进行审查,并考虑到功能下降,参与上传显示,功能减退可能性的风险比为0.79(95%CI:0.60-1.04).
    结论:使用基于步行活动的计步器和健康点计划与增强参与该计划的老年人的健康有关,代表了以人口为中心的针对所有公民的战略。
    OBJECTIVE: This study aimed to evaluate the association between the Yokohama Walking Point Program, which promotes walking through feedback on step counts and incentives, and the extension of healthy life expectancy.
    METHODS: A total of 4298 individuals aged over 65 years who responded to the 2013 and 2016 surveys and who were not certified as needing long-term care in 2016 were included in this study. The participants were categorized into \"non-participation,\" \"participation without uploading,\" and \"participation with uploading\" groups based on their involvement and uploading of pedometer data. The objective variable was the occurrence of long-term care certification and deaths over the subsequent four years. A modified Poisson regression model was applied, adjusting for 15 variables before project initiation.
    RESULTS: A total of 440 participants (10.2 %) were included in the \"participation with uploading\" group and 206 (4.8 %) in the \"participation without uploading\" group. Compared with \"non-participation,\" the risk ratio was 0.77 (95 % confidence interval (CI): 0.59-0.99) for \"participation with uploading\" and 1.02 (95 % CI: 0.75-1.38) for \"participation without uploading\". In the sensitivity analysis censoring death as an inapplicable outcome and considering functional decline, participation with uploading showed a risk ratio of 0.79 (95 % CI: 0.60-1.04) for the likelihood of functional decline.
    CONCLUSIONS: The use of pedometers and health point programs based on walking activity is associated with enhancing the health of older individuals participating in the program, representing a population-centric strategy targeting all citizens.
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  • 文章类型: Journal Article
    考虑到对卵子捐赠(ED)的需求不断增长,以及缺乏女性作为捐赠者来满足这一需求,学者们对诊所可能(最初)歪曲招募更多捐赠者的风险表示担忧。此外,(非)货币激励措施可能被用来试图影响潜在的捐赠者,这可能会给这些女性带来压力,或者导致她们放弃自己的担忧。由于互联网通常是信息的第一来源,第一印象会影响个人的选择,我们检查了生育诊所的网站,以探索它们如何呈现医疗风险,激励和情感诉求。内容分析和框架分析用于分析比利时的样本,西班牙和英国诊所网站。数据显示,网站主要关注极端和危险的风险和副作用(例如严重的OHSS),尽管捐赠者被告知不太严重但更频繁发生的风险和副作用(例如腹胀)是非常相关的,因为这些影响捐赠者的日常运作。欧洲ED的利他主义叙事在数据中占主导地位,尽管在西班牙和英国网站上发现了一些(隐藏的)财务激励措施。尽管如此,有关财务激励的所有信息仍然巧妙地呈现或与利他激励相结合。
    Considering the growing demand for egg donation (ED) and the scarcity of women coming forward as donors to meet this demand, scholars have expressed concerns that clinics may (initially) misrepresent risks to recruit more donors. Additionally, (non-)monetary incentives might be used to try to influence potential donors, which may pressure these women or cause them to dismiss their concerns. Since the internet is often the first source of information and first impressions influence individuals\' choices, we examined the websites of fertility clinics to explore how they present medical risks, incentives and emotional appeals. Content Analysis and Frame Analysis were used to analyze a sample of Belgian, Spanish and UK clinic websites. The data show that the websites mainly focus on extreme and dangerous risks and side effects (e.g. severe OHSS) even though it is highly relevant for donors to be informed about less severe but more frequently occurring risks and side effects (e.g. bloating), since those influence donors\' daily functioning. The altruistic narrative of ED in Europe was dominant in the data, although some (hidden) financial incentives were found on Spanish and UK websites. Nonetheless, all information about financial incentives still were presented subtly or in combination with altruistic incentives.
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  • 文章类型: Journal Article
    越来越多地采用财务激励措施来帮助提高一般实践中的护理标准。然而,它们对护理质量的影响尚不清楚。本研究旨在评估选择退出质量和成果框架(QOF)的做法的影响,英国一般惯例中的一项财务激励计划。
    回顾性研究了塔哈姆雷特的所有实践之前和之后,东伦敦。
    当地专员为实践提供了一种选择,即选择退出QOF而不进行经济处罚,而是选择当地设计的经济激励计划,以促进更全面的护理。我们将选择退出QOF的那些做法与继续进行的做法进行了比较。我们使用了国家,2016/17和2017/18年度公开可用的QOF成就数据。我们对16项QOF指标进行了分分析,以更好地了解干预措施的影响。
    在塔哈姆雷特的36种实践中,7决定继续使用QOF,29决定退出。干预措施导致选择退出QOF的实践的总QOF成就得分略有降低,但具有统计学意义。对16项QOF指标的次级分析显示,在扣除选择退出的做法的例外情况后,大多数成就得分在统计上显着下降。当包括例外时,两组实践之间的性能差异变得更小。
    取消QOF财务激励措施可能会导致与QOF相关指标的实现减少,但影响的大小似乎取决于QOF例外率。一种促进更全面的护理方法的替代激励计划似乎受到了一般做法的欢迎。
    UNASSIGNED: Financial incentives are being increasingly adopted to help improve standards of care within general practice. However their effects on care quality are unclear. This study aimed to evaluate the impact of practices opting out of the Quality and Outcomes Framework (QOF), a financial incentive scheme in UK general practice.
    UNASSIGNED: A retrospective before and after study of all practices in Tower Hamlets, east London.
    UNASSIGNED: Practices were given an option by local commissioners of opting out of QOF without a financial penalty and instead opting for a locally designed financial incentive scheme that promoted more holistic care. We compared those practices which opted out of QOF to those which continued. We used national, publicly available QOF achievement data from 2016/17 and 2017/18. We undertook a sub-analysis of 16 QOF indicators to better understand the impact of the intervention.
    UNASSIGNED: Of the 36 practices in Tower Hamlets, 7 decided to continue with QOF and 29 opted out. The intervention resulted in a small but statistically significant reduction in the total QOF achievement scores of practices which opted out of QOF. The sub-analysis of 16 QOF indicators showed statistically significant reductions in most of achievement scores net of exceptions for the practices that opted out. The differences in performance between the two cohorts of practices became smaller when exceptions were included.
    UNASSIGNED: The removal of QOF financial incentives can result in a reduction in achievement of QOF-related indicators but the size of the effect seems to depend on the QOF exception rates. An alternative incentive scheme that promotes a more holistic approach to care seems to be welcomed by general practices.
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  • 文章类型: Journal Article
    我们调查了剂量失败是否会促使老年人在涉及用步进动作击中目标的运动游戏中进行更多重复。Theeffectofdosedfailurewerestudiedinawithin-participantsdesigninwhichallparticipantsperformedthisexergameinbothaStandardcondition,一个人永远不会失败,在剂量失败的情况下,其中我们引入了大约30%的故障。为每个参与者随机选择条件的顺序(标准第一次或剂量失败首先)。结果显示,与标准条件相比,参与者在剂量失败条件下进行了更多的重复,而退出时的游戏持续时间和主观动机没有差异。这表明,剂量失败会促使老年人付出更大的努力来进行锻炼,而不会影响比赛持续时间或主观动机。
    We investigated whether dosed failure motivates older adults to perform more repetitions in an exergame that involves hitting targets with stepping movements. The effect of dosed failure was studied in a within-participants design in which all participants performed this exergame in both a Standard condition, in which one never fails, and in a Dosed Failure condition, in which we introduced about 30% failures. The order of conditions (Standard First or Dosed Failure first) was chosen randomly for each participant. Results showed that participants performed more repetitions in the Dosed Failure condition compared with the Standard condition, while play duration and subjective motivation at the moment of quitting did not differ. This shows that dosed failure motivated older adults to put a greater amount of effort to perform the exercise without affecting play duration or subjective motivation.
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  • 文章类型: Letter
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  • 文章类型: Journal Article
    税收减免和激励措施用于鼓励私营卫生部门提供有利于社区卫生的服务。这项研究的目的是探讨与纳税有关的问题,提供的激励措施,投资回报,实践满意,以及2021年在哈考特港参加会议的私人健康从业者的计划。
    在哈考特港的两次全国性活动中进行了描述性横断面研究,河流州,尼日利亚十月和2021年12月,在会议与会者中使用自我管理问卷。使用IBM社会科学统计软件包(SPSS)20.0版分析获得的数据,并在表中显示。
    共有一百六十六(166)名受访者参与了这项研究。104名(62.7%)受访者认为他们经历了政府机构的多重征税。大多数受访者向各级政府缴纳了至少五万及以上的税款。一百四十二(85.5%)的受访者认为,他们没有从政府那里获得任何私人医疗业务的激励。53人(31.9%)不满意,55(33.1%)受访者设法在商业环境中生存。
    尼日利亚的私人医疗从业者经历多重征税和缺乏政府激励措施。对投资回报的不满是普遍存在的。因此,需要进行包容性的卫生部门改革,以部分减少人才外流的可能性。
    UNASSIGNED: Tax relief and incentives are utilized to encourage the private health sector to provide services that are advantageous to community health. The aim of this study was to explore the issues related to taxes paid, incentives provided, returns on investment, satisfaction with practice, and plans of private health practitioners who were conference attendees in Port Harcourt in 2021.
    UNASSIGNED: A descriptive cross-sectional study was carried out at two national events in Port Harcourt, Rivers State, Nigeria in October, and December 2021, among conference attendees using self-administered questionnaires. Data obtained was analyzed using the IBM Statistical Package for the Social Sciences (SPSS) version 20.0 and presented in tables.
    UNASSIGNED: A total of one hundred and sixty-six (166) respondents were involved in the study. One hundred and four (62.7%) respondents believed they experienced multiple taxation from agencies of government. Most respondents paid at least fifty thousand and above as taxes to various levels of government. One hundred and forty-two (85.5%) respondents believed they did not receive any incentive from governments for their private health businesses. Fifty-three (31.9%) were not satisfied, while55 (33.1%) respondents were managing to survive in the business environment.
    UNASSIGNED: Private healthcare practitioners in Nigeria experience multiple taxation and a lack of incentives from governments. Dissatisfaction with the return on investment is prevalent. Inclusive health sector reform that will partly reduce the potential for brain drain is therefore needed.
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  • 文章类型: Journal Article
    背景护理点超声(POCUS)对许多经验丰富的急诊医生具有破坏性,因为它需要具备新的物理技能,实时图像解释,和导航的新软件提交到电子健康记录(EHR)。用于临床决策的已执行POCUS研究的不完整文档代表了潜在的法医学责任,可能会使患者暴露于重复或潜在不必要的成像,这是一个错失的报销机会。确定EDPOCUS文档完成的有效促进者需要额外的调查。方法在本混合方法研究的第一部分,根据最近的POCUS文档表现,将符合条件的主治医师分层为使用水平(\"高\"/\"低\"/\"从不\").对高利用率和低利用率进行了半结构化访谈,以探讨他们对POCUS提交工作流程的看法以及对各种拟议干预措施的接受度。使用探讨感知有用性和可用性的主题分析对定性数据进行了分析。研究的第二部分包括两个干预阶段。首先,达到最低POCUS文件数量的医师获得额外的轮班安排灵活性奖励.在第二阶段,获得最多采访支持的干预,每日文档提醒电子邮件,已实施。主要结果是按提交的所有研究除以每月进行的所有研究(提交加上未提交)计算的个人POCUS记录率。提供商级别的月度数据汇总为部门费率。结果对12名医师进行了访谈,最高的六个,最低的文档四分位数的六个。两组都支持相同的两项干预措施:提醒电子邮件排名第一,然后货币奖励排名第二。高利用率强调POCUS的临床实用性,而低使用率的人对“双重计费”和暴露于不确定的扫描解释的法医学责任表示担忧。对于低利用率者,文件的决定可能取决于执行住院医师显示的信心。两组人都对使用单独的程序感到沮丧,Qpath(TelexyHealthcare,Inc,枫树岭,不列颠哥伦比亚省,加拿大),用于POCUS文档。在干预第一阶段,随着时间表要求激励措施的引入,部门文件总数从44.6%增加到60.1%。在所有文档四分位数中都可以看到这种改进。在干预第二阶段增加了每日文档提醒电子邮件后,部门比率保持稳定,没有进一步改善。当提醒电子邮件停止但休息日请求激励仍在继续时,部门费率没有下降。结论实施非财务班次调度激励措施与部门POCUS文档率的最大增长相关。受访者错误地预测,电子邮件提醒将是最有影响力的干预措施,突显了医生的感知与行为改变的有效驱动因素之间的不匹配。进一步的调查可能侧重于确定时间表请求激励的孤立影响的大小和寿命,正如人们可能期望的那样,边际效用递减。
    Background Point-of-care ultrasound (POCUS) has been disruptive to many experienced emergency physicians as it requires competence in a new physical skill, real-time image interpretation, and navigation of novel software for submission to the electronic health record (EHR). Incomplete documentation of a performed POCUS study used for clinical decision-making represents a potential medicolegal liability, may expose the patient to repetitive or potentially unnecessary imaging, and is a missed opportunity for reimbursement. Identifying effective facilitators of ED POCUS documentation completion requires additional investigation. Methods In the first part of this mixed-methods study, eligible attending physicians were stratified into levels of use (\"high\"/\"low\"/\"never\") based on recent POCUS documentation performance. Semi-structured interviews were conducted with high and low utilizers to explore their perceptions of the POCUS submission workflow and their receptivity to various proposed interventions. Qualitative data were analyzed using a thematic analysis that explored perceived usefulness and usability. The second part of the study consisted of two intervention phases. First, physicians achieving minimum POCUS documentation numbers were rewarded with additional shift scheduling flexibility. In the second phase, the intervention that garnered the most interview support, daily documentation reminder emails, was implemented. The primary outcome was the individual POCUS documentation rates calculated as all studies submitted divided by all studies performed (submitted plus unsubmitted) per month. Provider-level monthly data was aggregated into a departmental rate. Results Interviews were conducted with 12 physicians, six from the highest and six from the lowest documentation quartiles. Both groups supported the same two proposed interventions: reminder emails ranked first, then monetary rewards ranked second. High utilizers emphasized the clinical utility of POCUS, whereas low utilizers expressed concerns over \"double billing\" and exposure to medicolegal liability with uncertain scan interpretations. For low utilizers, a documentation decision could be dependent on the performing resident physician\'s displayed confidence. Both groups voiced frustration with the need to use a separate program, Qpath (Telexy Healthcare, Inc, Maple Ridge, British Columbia, Canada), for POCUS documentation. During intervention phase one, the aggregate departmental documentation rate increased from 44.6% to 60.1% with the introduction of the schedule request incentive. This improvement was seen across all documentation quartiles. The departmental rate remained stable and did not improve further following the addition of the daily documentation reminder emails in intervention phase two. When reminder emails ceased yet the day-off request incentive continued, the departmental rate did not drop. Conclusions The implementation of a non-financial shift scheduling incentive correlated with the largest increase in departmental POCUS documentation rate. Interviewees incorrectly predicted that email reminders would be the most influential intervention highlighting a mismatch between physician perception and effective drivers of behavior change. Further investigation may focus on determining the size and longevity of the isolated impact of a schedule request incentive, as one might expect diminishing marginal utility.
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  • 文章类型: Journal Article
    这项研究通过研究消除障碍的激励措施-一天的交通代金券-促进献血的有效性,解决了发展中国家献血率低的挑战。利用2018年3月至2020年5月期间收集的来自巴西血液采集机构(BCA)的23,750名捐赠者的纵向数据集,我们研究了这项运动对捐赠率的短期和长期影响。我们的结果表明,激励措施对运动当天的捐赠尝试和成功捐赠都有很大的积极影响。然而,干预的短期成功带来了意想不到的后果:在干预日期间,潜在捐赠者在BCA的等待时间显着增加,这可能有助于解释24个月随访对回报率的负面影响。尽管有这些相反的结果,一日献血奖励的净效果仍然是积极的,为BCA提供有价值的见解,旨在加强捐助者的招募和保留策略,并强调需要在眼前的利益与潜在的长期影响之间取得平衡。
    This study addresses the challenge of low blood donation rates in developing countries by examining the effectiveness of a barrier-removal incentive-a one-day transportation voucher-to promote blood donation. Utilizing a longitudinal dataset of 23,750 donors from a Brazilian blood collection agency (BCA) collected between March 2018 and May 2020, we examine the short and long-term effects of this campaign on donation rates. Our results show that the incentive had a large positive influence on both donation attempts and successful donations on the day of the campaign. However, the short-term success of the intervention had an unintended consequence: the significant increase in prospective donors\' waiting time at the BCA during the intervention day, which may help explain the negative impact on return rates in the 24-month follow-up. Despite these opposing outcomes, the net effect of the one-day blood donation incentive was still positive, offering valuable insights for BCAs aiming to enhance donor recruitment and retention strategies and emphasizing the need to balance immediate benefits with potential long-term impacts.
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