2023-09-28 14:46:10 +00:00
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abstract: 'Background: Quality measurements in primary healthcare (PHC) have become
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an essential component for improving diabetes outcomes in many
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high-income countries. However, little is known about their
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implementation within the Chinese health-system context and how they are
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perceived by patients, physicians, and policy-makers. We examined
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stakeholders??? perceptions of quality and performance measurements for
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primary diabetes care in Shanghai, China, and analyzed facilitators and
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barriers to implementation. Methods: In-depth interviews with 26 key
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stakeholders were conducted from 2018 to 2019. Participants were sampled
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from two hospitals, four community healthcare centers (CHCs), and four
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institutes involved in regulating CHCs. The Consolidated Framework for
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Implementation Research (CFIR) guided data analysis. Results: Existing
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quality measurements were uniformly implemented via a top-down process,
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with daily monitoring of family doctors??? work and pay-for-performance
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incentives. Barriers included excluding frontline clinicians from
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indicator planning, a lack of transparent reporting, and a rigid
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organizational culture with limited bottom-up feedback. Findings under
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the CFIR construct ???organizational incentives??? suggested that
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current pay-for-performance incentives function as a ???double-edged
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sword,??? increasing family doctors??? motivation to excel while
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creating pressures to ???game the system??? among some physicians. When
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considering the CFIR construct ???reflecting and evaluating,???
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policy-makers perceived the online evaluation application ??? which
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provides daily reports on family doctors??? work ??? to be an essential
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tool for improving quality; however, this information was not visible to
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patients. Findings included under the ???network and communication???
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construct showed that specialists support the work of family doctors by
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providing training and patient consultations in CHCs. Conclusion: The
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quality of healthcare could be considerably enhanced by involving
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patients and physicians in decisions on quality measurement.
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Strengthening hospital???community partnerships can improve the quality
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of primary care in hospital-centric systems. The case of Shanghai
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provides compelling policy lessons for other health systems faced with
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the challenge of improving PHC.'
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affiliation: 'Rasooly, A (Corresponding Author), Ben Gurion Univ Negev, Sch Publ Hlth,
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Beer Sheva, Israel.
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Rasooly, Alon; Ellen, Moriah E.; Davidovitch, Nadav, Ben Gurion Univ Negev, Sch
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Publ Hlth, Beer Sheva, Israel.
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Pan, Yancen, Univ Calif Los Angeles, Fielding Sch Publ Hlth, Dept Epidemiol, Los
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Angeles, CA USA.
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Tang, Zhenqing; Jiangjiang, He, Shanghai Hlth Dev Res Ctr, Shanghai, Peoples R China.
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Manor, Orly, Hebrew Univ Jerusalem, Braun Sch Publ Hlth \& Community Med, Jerusalem,
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Israel.
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Hu, Shanlian, Fudan Univ, Sch Publ Hlth, Shanghai, Peoples R China.'
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author: Rasooly, Alon and Pan, Yancen and Tang, Zhenqing and Jiangjiang, He and Ellen,
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Moriah E. and Manor, Orly and Hu, Shanlian and Davidovitch, Nadav
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author-email: rasooly@post.bgu.ac.il
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author_list:
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- family: Rasooly
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given: Alon
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- family: Pan
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given: Yancen
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- family: Tang
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given: Zhenqing
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- family: Jiangjiang
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given: He
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- family: Ellen
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given: Moriah E.
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- family: Manor
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given: Orly
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- family: Hu
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given: Shanlian
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- family: Davidovitch
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given: Nadav
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da: '2023-09-28'
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doi: 10.34172/ijhpm.2022.6372
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earlyaccessdate: JUN 2022
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eissn: 2322-5939
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files: []
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journal: INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT
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keywords: 'Quality Indicators; Primary Health Care; Diabetes Mellitus; China; CFIR;
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Implementation Science'
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keywords-plus: 'PRIMARY-HEALTH-CARE; RISK-FACTORS; PAY; PROGRAM; DISPARITIES; OUTCOMES;
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TAIWAN; REFORM; IMPACT'
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language: English
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month: 2022 JUN 7
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number-of-cited-references: '72'
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orcid-numbers: 'Davidovitch, Nadav/0000-0001-5709-9265
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Ellen, Moriah/0000-0001-7127-7283
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Rasooly, Alon/0000-0002-0388-9883'
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papis_id: 6758e67372b5f43a626f8fdc34be8520
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ref: Rasooly2022qualityperformance
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times-cited: '0'
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title: 'Quality and Performance Measurement in Primary Diabetes Care: A Qualitative
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Study in Urban China'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000810407900001
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usage-count-last-180-days: '12'
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usage-count-since-2013: '24'
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web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
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year: '2022'
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