Despite widespread use, evidence is sparse on whether financial incentives in healthcare should be linked to structure, process or outcome. We examine the impact of different incentive types on the quantity and effectiveness of referrals made by general practices to a new national prevention programme in England. We measured effectiveness by the number of referrals resulting in programme attendance. We surveyed local commissioners about their use of financial incentives and linked this information to numbers of programme referrals and attendances from 5170 general practices between April 2016 and March 2018. We used multivariate probit regressions to identify commissioner characteristics associated with the use of different incentive types and negative binomial regressions to estimate their effect on practice rates of referral and attendance. Financial incentives were offered by commissioners in the majority of areas (89%), with 38% using structure incentives, 69% using process incentives and 22% using outcome incentives. Compared to practices without financial incentives, neither structure nor process incentives were associated with statistically significant increases in referrals or attendances, but outcome incentives were associated with 84% more referrals and 93% more attendances. Outcome incentives were the only form of pay-for-performance to stimulate more participation in this national disease prevention programme.

中文翻译：

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结构、过程和结果激励对初级保健转诊到国家预防计划的影响

尽管广泛使用，但关于医疗保健中的财务激励是否应与结构、过程或结果相关联的证据很少。我们研究了不同的激励类型对英国一项新的国家预防计划的一般做法转介的数量和有效性的影响。我们通过推荐参加计划的人数来衡量有效性。我们调查了当地专员关于他们使用财务激励的情况，并将此信息与 2016 年 4 月至 2018 年 3 月期间 5170 个一般实践的项目推荐和出席人数联系起来。我们使用多元概率回归来确定与使用不同激励类型相关的专员特征和负二项式回归来估计它们对推荐和出勤率的影响。大多数领域（89%）的委员提供财政激励，其中 38% 使用结构激励，69%​​ 使用过程激励，22% 使用结果激励。与没有经济激励的实践相比，结构和流程激励都与转诊或出席率的统计显着增加无关，但结果激励与 84% 的转诊和 93% 的出席率有关。结果奖励是唯一一种按绩效付费的形式，可以刺激更多人参与这项国家疾病预防计划。无论是结构还是过程激励都与转诊或出席率的统计显着增加无关，但结果激励与 84% 的转诊和 93% 的出席率有关。结果奖励是唯一一种按绩效付费的形式，可以刺激更多人参与这项国家疾病预防计划。无论是结构激励还是过​​程激励都与转诊或出席率的统计显着增加无关，但结果激励与转诊率增加 84% 和出席率增加 93% 相关。结果奖励是唯一一种按绩效付费的形式，可以刺激更多人参与这项国家疾病预防计划。