Evidence map›Paper›PMID 26671067›Full record

Observational studyScandinavian journal of primary health care2015

Short-term effects of a pay-for-performance programme for diabetes in a primary care setting: an observational study.

H Ödesjö, A Anell, S Gudbjörnsdottir, J Thorn, S Björck

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in Scandinavian journal of primary health care, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
13citing papers in PubMed, 4 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

13 citing papers in PubMed, 4 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Effects of pay-for-performance for primary care physicians on diabetes outcomes in single-payer health systems: a systematic review.The European journal of health economics : HEPAC : health economics in prevention and care · 2019
    Pooled it
  4. Payment methods for outpatient care facilities.The Cochrane database of systematic reviews · 2017
    Pooled it
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

H Ödesjöa Department of Public Health and Community Medicine , Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Primary Health Care , Region Västra Götaland , Sweden ;
A Anellb Lund University School of Economics and Management , Sweden ;
S Gudbjörnsdottirc Department of Molecular and Clinical Medicine , Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Sweden.
J Thorna Department of Public Health and Community Medicine , Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Primary Health Care , Region Västra Götaland , Sweden ;
S Björckc Department of Molecular and Clinical Medicine , Institute of Medicine, Sahlgrenska Academy, University of Gothenburg , Sweden.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveA pay-for-performance (P4P) programme for primary care was introduced in 2011 by a Swedish county (with 1.6 million inhabitants). Effects on register entry practice and comparability of data for patients with diabetes mellitus were assessed. DESIGN AND

settingObservational study analysing short-term outcomes before and after introduction of a P4P programme in the study county as compared with a reference county. SUBJECTS: A total of 84 053 patients reported to the National Diabetes Register by 349 primary care units.

main outcome measuresCompleteness of data, level and target achievement of glycated haemoglobin (HbA1c), blood pressure (BP), and LDL cholesterol (LDL).

resultsIn the study county, newly recruited patients who were entered during the incentive programme were less well controlled than existing patients in the register - they had higher HbA1c (54.9 [54.5-55.4] vs. 53.7 [53.6-53.9] mmol/mol), BP, and LDL. The percentage of patients with entry of BP, HbA1c, LDL, albuminuria, and smoking increased in the study county but not in the reference county (+26.3% vs -1.5%). In the study county, with an incentive for BP < 130/80 mmHg, BP data entry behaviour was altered with an increased preference for sub-target BP values and a decline in zero end-digit readings (38.3% vs. 33.7%, p < 0.001).

conclusionP4P led to increased register entry, increased completeness of data, and altered BP entry behaviour. Analysis of newly added patients and data shows that missing patients and data can cause performance to be overestimated. Potential effects on reporting quality should be considered when designing payment programmes. Key points A pay-for-performance programme, with a focus on data entry, was introduced in a primary care region in Sweden. Register data entry in the National Diabetes Register increased and registration behaviour was altered, especially for blood pressure. Newly entered patients and data during the incentive programme were less well controlled. Missing data in a quality register can cause performance to be overestimated.

Indexed as

Reimbursement, IncentiveAdultAgedBlood PressureCholesterol, LDLDiabetes MellitusFemaleGlycated HemoglobinHumansMaleMiddle AgedPrevalencePrimary Health CareQuality Indicators, Health CareRegistriesSmokingCholesterol, LDLGlycated HemoglobinDiabetes mellitusgeneral practicehealth care quality assessmentpay for performanceprimary health carequality indicatorsSweden

Identifiers

PMID26671067
PMCPMC4750739

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.