Systematic review: Effects, design choices, and context of pay-for-performance in health care

<p>Abstract</p> <p>Background</p> <p>Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. Substantial heterogeneity exists in the development and implementation of P4P in health care and its effects. This paper summarizes evidence, obtained from studies published between January 1990 and July 2009, concerning P4P effects, as well as evidence on the impact of design choices and contextual mediators on these effects. Effect domains include clinical effectiveness, access and equity, coordination and continuity, patient-centeredness, and cost-effectiveness.</p> <p>Methods</p> <p>The systematic review made use of electronic database searching, reference screening, forward citation tracking and expert consultation. The following databases were searched: Cochrane Library, EconLit, Embase, Medline, PsychINFO, and Web of Science. Studies that evaluate P4P effects in primary care or acute hospital care medicine were included. Papers concerning other target groups or settings, having no empirical evaluation design or not complying with the P4P definition were excluded. According to study design nine validated quality appraisal tools and reporting statements were applied. Data were extracted and summarized into evidence tables independently by two reviewers.</p> <p>Results</p> <p>One hundred twenty-eight evaluation studies provide a large body of evidence -to be interpreted with caution- concerning the effects of P4P on clinical effectiveness and equity of care. However, less evidence on the impact on coordination, continuity, patient-centeredness and cost-effectiveness was found. P4P effects can be judged to be encouraging or disappointing, depending on the primary mission of the P4P program: supporting minimal quality standards and/or boosting quality improvement. Moreover, the effects of P4P interventions varied according to design choices and characteristics of the context in which it was introduced.</p> <p>Future P4P programs should (1) select and define P4P targets on the basis of baseline room for improvement, (2) make use of process and (intermediary) outcome indicators as target measures, (3) involve stakeholders and communicate information about the programs thoroughly and directly, (4) implement a uniform P4P design across payers, (5) focus on both quality improvement and achievement, and (6) distribute incentives to the individual and/or team level.</p> <p>Conclusions</p> <p>P4P programs result in the full spectrum of possible effects for specific targets, from absent or negligible to strongly beneficial. Based on the evidence the review has provided further indications on how effect findings are likely to relate to P4P design choices and context. The provided best practice hypotheses should be tested in future research.</p

Does electrification spur the fertility transition? evidence from Indonesia

We analyze various pathways through which access to electricity affects fertility in Indonesia, using a district difference-in-difference approach. The electrification rate increased by 65 % over the study period, and our results suggest that the subsequent effects on fertility account for about 18 % to 24 % of the overall decline in fertility. A key channel is increased exposure to television. Using in addition several waves of Demographic and Health Surveys, we find suggestive evidence that increased exposure to TV affects, in particular, fertility preferences and increases the effective use of contraception. Reduced child mortality seems to be another important pathway

Structural study of the apatite Nd8Sr2Si6O26 by laue neutron diffraction and single-crystal raman spectroscopy

A single-crystal structure determination of Nd8Sr2Si6O26 apatite, a prototype intermediate-temperature electrolyte for solid oxide fuel cells grown by the floating-zone method, was completed using the combination of Laue neutron diffraction and Raman spectroscopy. While neutron diffraction was in good agreement with P6₃/m symmetry, the possibility of P6₃ could not be convincingly excluded. This ambiguity was removed by the collection of orientation-dependent Raman spectra that could only be consistent with P6₃/m. The composition of Nd8Sr2Si6O26 was independently verified by powder X-ray diffraction in combination with electron probe microanalysis, with the latter confirming a homogeneous distribution of Sr and the absence of chemical zonation commonly observed in apatites. This comprehensive crystallochemical description of Nd8Sr2Si6O26 provides a baseline to quantify the efficacy of cation vacancies, oxygen superstoichiometry, and symmetry modification for promoting oxygen-ion mobility

Structural study of the apatite Nd₈Sr₂Si₆O₂₆ by Laue neutron diffraction and single-crystal Raman spectroscopy

A single-crystal structure determination of Nd8Sr2Si6O26 apatite, a prototype intermediate-temperature electrolyte for solid oxide fuel cells grown by the floating-zone method, was completed using the combination of Laue neutron diffraction and Raman spectroscopy. While neutron diffraction was in good agreement with P63/m symmetry, the possibility of P63 could not be convincingly excluded. This ambiguity was removed by the collection of orientation-dependent Raman spectra that could only be consistent with P63/m. The composition of Nd8Sr2Si6O26 was independently verified by powder X-ray diffraction in combination with electron probe microanalysis, with the latter confirming a homogeneous distribution of Sr and the absence of chemical zonation commonly observed in apatites. This comprehensive crystallochemical description of Nd8Sr2Si6O26 provides a baseline to quantify the efficacy of cation vacancies, oxygen superstoichiometry, and symmetry modification for promoting oxygen-ion mobility.ASTAR (Agency for Sci., Tech. and Research, S’pore)Accepted versio

Oxygen Migration in Dense Spark Plasma Sintered Aluminum-Doped Neodymium Silicate Apatite Electrolytes

Neodymium silicate apatites are promising intermediate temperature (500°C–700°C) electrolytes for solid oxide fuel cells. The introduction of Al promotes isotropic percolation of O2−, and at low levels (0.83–2.0 wt% Al) enhances bulk conductivity. To better understand the effect of Al-doping on intrinsic conductivity, and the impact of grain boundaries on the transport, dense Nd9.33+x/3AlxSi6−xO26 (0 ≤ x ≤ 2) pellets were prepared by spark plasma sintering. Phase purity of the products was established by powder X-ray diffraction and the microstructure examined by scanning electron microscopy. The ionic conductivity measured by AC impedance spectroscopy for the spark plasma sintered ceramics were compared with transport in single crystals of similar composition. Intermediate Al-doping (0.5 ≤ x ≤ 1.5) delivered superior overall conductivity for both the polycrystalline and single crystal specimens.ASTAR (Agency for Sci., Tech. and Research, S’pore)Accepted versio

Oxygen migration in dense spark plasma sintered aluminum-doped neodymium silicate apatite electrolytes

Neodymium silicate apatites are promising intermediate temperature (500°C-700°C) electrolytes for solid oxide fuel cells. The introduction of Al promotes isotropic percolation of O2-, and at low levels (0.83-2.0 wt% Al) enhances bulk conductivity. To b

Structural Study of the Apatite Nd₈Sr₂Si₆O₂₆ by Laue Neutron Diffraction and Single-Crystal Raman Spectroscopy

A single-crystal structure determination of Nd₈Sr₂Si₆O₂₆ apatite, a prototype intermediate-temperature electrolyte for solid oxide fuel cells grown by the floating-zone method, was completed using the combination of Laue neutron diffraction and Raman spectroscopy. While neutron diffraction was in good agreement with <i>P</i>6₃/<i>m</i> symmetry, the possibility of <i>P</i>6₃ could not be convincingly excluded. This ambiguity was removed by the collection of orientation-dependent Raman spectra that could only be consistent with <i>P</i>6₃/<i>m</i>. The composition of Nd₈Sr₂Si₆O₂₆ was independently verified by powder X-ray diffraction in combination with electron probe microanalysis, with the latter confirming a homogeneous distribution of Sr and the absence of chemical zonation commonly observed in apatites. This comprehensive crystallochemical description of Nd₈Sr₂Si₆O₂₆ provides a baseline to quantify the efficacy of cation vacancies, oxygen superstoichiometry, and symmetry modification for promoting oxygen-ion mobility

Structural Study of the Apatite Nd₈Sr₂Si₆O₂₆ by Laue Neutron Diffraction and Single-Crystal Raman Spectroscopy

A single-crystal structure determination of Nd₈Sr₂Si₆O₂₆ apatite, a prototype intermediate-temperature electrolyte for solid oxide fuel cells grown by the floating-zone method, was completed using the combination of Laue neutron diffraction and Raman spectroscopy. While neutron diffraction was in good agreement with <i>P</i>6₃/<i>m</i> symmetry, the possibility of <i>P</i>6₃ could not be convincingly excluded. This ambiguity was removed by the collection of orientation-dependent Raman spectra that could only be consistent with <i>P</i>6₃/<i>m</i>. The composition of Nd₈Sr₂Si₆O₂₆ was independently verified by powder X-ray diffraction in combination with electron probe microanalysis, with the latter confirming a homogeneous distribution of Sr and the absence of chemical zonation commonly observed in apatites. This comprehensive crystallochemical description of Nd₈Sr₂Si₆O₂₆ provides a baseline to quantify the efficacy of cation vacancies, oxygen superstoichiometry, and symmetry modification for promoting oxygen-ion mobility