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Purpose: Drawing on the pay-for-performance (P4P) and job satisfaction literatures through an analysis of qualitative studies published on the topic, the purpose of this study is to investigate the effect of a P4P-based system on job satisfaction and dissatisfaction among health care workers. Design/methodology/approach: A meta-synthesis of the qualitative literature was conducted to investigate health care workers' opinions, perceptions and behaviors and fully understand what processes generate job satisfaction or dissatisfaction under P4P systems. Findings: The findings suggest that P4P systems impact the job (dis-)satisfaction of health care workers based on the institutional, organizational, geographic and cultural context of reference. Specifically, job satisfaction – and thus motivation, occupational well-being and work engagement – can occur when the context is supportive, whereas job dissatisfaction – and thus work stress and pressure, burnout and work-life balance issues and distraction – is generated in the case of unsupportive contexts. Moreover, the findings suggest a virtuous/vicious circle whereby job satisfaction leads to positive performance and further fuels job satisfaction, while conversely job dissatisfaction generates worse performance, and this further worsens worker satisfaction. Originality/value: There is a lack of studies comparing and analyzing current evidence on the job (dis-)satisfaction of health care workers operating in different contexts based on the reward system. This is the first research to analyze a significant number of studies with reference to the relation between P4P and job (dis-)satisfaction, which are topics in need of further study and investigation in health care settings around the world. [ABSTRACT FROM AUTHOR]

BackgroundPay-for-performance (P4P) models are intended to promote quality of care in both hospitals and primary care settings. They are considered as a means of changing medical practices, particularly in primary care.ObjectivesThe first objective of this study was to assess how performance indicators changed over time, measured through “Remuneration on Public Health Objectives” (ROSP) scores, between 2017 and 2020 in a large French region (Grand Est region), and to compare this evolution in the rural vs. urban areas of the region. The second objective was to focus on the area with the least improvement in ROSP scores and to investigate whether the scores and the available sociodemographic characteristics of the area were associated.MethodsFirst, we measured the evolution over time of P4P indicators (i.e., ROSP scores) obtained from the regional health insurance system, for GP practices in the Grand Est region between 2017 and 2020. We then compared the scores between the Aube Department and the rest of the region (urban areas). To address the second objective, we focused on the area found to have the least improvement in indicators to investigate whether there was a relationship between ROSP score and sociodemographic characteristics.ResultsMore than 40,000 scores were collected. We observed an overall improvement in scores over the study period. The urban area (Grand Est region minus the Aube) scored better than the rural area (Aube) for chronic disease management [median 0.91 (0.84–0.95) vs. 0.90(0.79–0.94), p < 0.001] and prevention [median 0.36 (0.22–0.45) vs. 0.33 (0.17–0.43), p < 0.001], but not for efficiency, where the rural area (Aube) performed better [median 0.67(0.56–0.74) vs. 0.69 (0.57–0.75 in the rest of the Grand Est region, p = 0.004]. In the rural area, we found no significant association between ROSP scores and sociodemographic characteristics, except for extreme rurality in some sub-areas.ConclusionsAt the regional level, the overall improvement in scores observed between 2017 and 2020 suggests that the implementation of ROSP indicators have improved the quality of care, particularly in urban areas. These results also suggest that efforts should be focused on rural areas, which already had the lowest scores at the start of the P4P program.

In this paper, a circular objects detection method for Autonomous Underwater Vehicle (AUV) docking is proposed, based on the Dynamic Vision Sensor (DVS) and the Spiking Neural Network (SNN) framework. In contrast to the related work, the proposed method not only avoids motion blur caused by frame-based recognition during docking procedure but also reduces data redundancy with limited on-chip resources. First, four coplanar and rectangular constrained circular light sources are constructed as the docking landmark. By combining asynchronous Hough circle transform with the SNN model, the coordinates of landmarks in the image are detected. Second, a Perspective-4-Point (P4P) algorithm is utilized to calculate the relative pose between AUV and the landmark. In addition, a spatiotemporal filter is also used to eliminate noises generated by the background. Finally, experimental results are demonstrated from both software simulation and experimental pool, respectively, to verify the proposed method. It is concluded that the proposed method achieves better performance in accuracy and efficiency in underwater docking scenarios. [ABSTRACT FROM AUTHOR]

Abstract Background Value-based reimbursement programs have become increasingly common. However, little is known about the effect of such programs on patient reported outcomes. Thus, the aim of this study was to analyze the effect of introducing a value-based reimbursement program on patient reported outcome measures and to explore whether a selection bias towards less complicated patients occurred. Methods This is a retrospective observational study with a before and after design based on the introduction of a value-based reimbursement program in Region Stockholm, Sweden. We analyzed patient level data from inpatient and outpatient care of patients undergoing lumbar spine surgery during 2006–2015. Patient reported outcome measures used was Global Assessment, EQ-5D-3L and Oswestry Disability Index. The case-mix of surgically treated patients was analyzed using medical and socioeconomic factors. Results The value-based reimbursement program did not have any effect on targeted or non-targeted patient reported outcome measures. Moreover, the share of surgically treated patients with risk factors such as having comorbidities and being born outside of Europe increased after the introduction. Hence, the value-based reimbursement program did not encourage discrimination against sicker patients. However, the income was higher among patients surgically treated after the introduction of the value-based reimbursement. This indicates that a value-based reimbursement program may contribute to increased inequalities in access to healthcare. Conclusions The value-based reimbursement program did not have any effect on patient reported outcome measures. Our study contributes to the understanding of the effects of a value-based reimbursement program on patient reported outcome measures and to what extent cherry-picking arises.

Objective: This study was conducted to investigate the challenges faced in the implementation of the pay-for-performance system in Iran’s family physician program. Study design: Qualitative. Place and duration of study: The study was conducted with 32 key informants at the family physician program at the Tabriz University of Medical Sciences between May 2018 and June 2018. Method: This is a qualitative study. A purposeful sampling method was used with only one inclusion criterion for participants: five years of experience in the family physician program. The researchers conducted 17 individual and group non-structured interviews and examined participants’ perspectives on the challenges faced in the implementation of the pay-for-performance system in the family physician program. Content analysis was conducted on the obtained data. Results: This study identified 7 themes, 14 sub-themes, and 46 items related to the challenges in the implementation of pay-for-performance systems in Iran’s family physician program. The main themes are: workload, training, program cultivation, payment, assessment and monitoring, information management, and level of authority. Other sub-challenges were also identified. Conclusion: The study results demonstrate some notable challenges faced in the implementation of the pay-for-performance system. This information can be helpful to managers and policymakers.

In this paper, a circular objects detection method for Autonomous Underwater Vehicle (AUV) docking is proposed, based on the Dynamic Vision Sensor (DVS) and the Spiking Neural Network (SNN) framework. In contrast to the related work, the proposed method not only avoids motion blur caused by frame-based recognition during docking procedure but also reduces data redundancy with limited on-chip resources. First, four coplanar and rectangular constrained circular light sources are constructed as the docking landmark. By combining asynchronous Hough circle transform with the SNN model, the coordinates of landmarks in the image are detected. Second, a Perspective-4-Point (P4P) algorithm is utilized to calculate the relative pose between AUV and the landmark. In addition, a spatiotemporal filter is also used to eliminate noises generated by the background. Finally, experimental results are demonstrated from both software simulation and experimental pool, respectively, to verify the proposed method. It is concluded that the proposed method achieves better performance in accuracy and efficiency in underwater docking scenarios.

The perspective n-point problem (PnP), or a three-point photogrammetric resection in space, consists of the problem of finding the position and the orientation of the model of the camera of the central projection by the assigned spatial coordinates of the given points and by the corresponding coordinates of their projections on the image. Due to the available applications in robotics and machine vision, direct noniterative methods for solving such a problem are of interest. The well known general method of the direct noniterative solution of the PnP problem in the case of four control points (n = 4) uses double linearization and seems to be rather cumbersome. This paper presents an alternative simpler solution for the considered problem in the case of n = 4. The proposed method reduces the computing requirements for solving this problem. In the case of more control points, the solution obtained for four points can be used as the initial approximation for the Gauss–Newton iterations or in the RANSAC calculation scheme. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to investigate the challenges faced in the implementation of the pay-for-performance system in Iran’s family physician program. Study design: Qualitative. Place and duration of study: The study was conducted with 32 key informants at the family physician program at the Tabriz University of Medical Sciences between May 2018 and June 2018. Method: This is a qualitative study. A purposeful sampling method was used with only one inclusion criterion for participants: five years of experience in the family physician program. The researchers conducted 17 individual and group non-structured interviews and examined participants’ perspectives on the challenges faced in the implementation of the pay-for-performance system in the family physician program. Content analysis was conducted on the obtained data. Results: This study identified 7 themes, 14 sub-themes, and 46 items related to the challenges in the implementation of pay-for-performance systems in Iran’s family physician program. The main themes are: workload, training, program cultivation, payment, assessment and monitoring, information management, and level of authority. Other sub-challenges were also identified. Conclusion: The study results demonstrate some notable challenges faced in the implementation of the pay-for-performance system. This information can be helpful to managers and policymakers. [ABSTRACT FROM AUTHOR]

Abstract Background To identify, characterize and compare existing pay-for-performance approaches and their impact on the quality of care and efficiency in ophthalmology. Methods A systematic evidence-based review was conducted. English, French and German written literature published between 2000 and 2015 were searched in the following databases: Medline (via PubMed), NCBI web site, Scopus, Web of Knowledge, Econlit and the Cochrane Library. Empirical as well as descriptive articles were included. Controlled clinical trials, meta-analyses, randomized controlled studies as well as observational studies were included as empirical articles. Systematic characterization of identified pay-for-performance approaches (P4P approaches) was conducted according to the “Model for Implementing and Monitoring Incentives for Quality” (MIMIQ). Methodological quality of empirical articles was assessed according to the Critical Appraisal Skills Programme (CASP) checklists. Results Overall, 13 relevant articles were included. Eleven articles were descriptive and two articles included empirical analyses. Based on these articles, four different pay-for-performance approaches implemented in the United States were identified. With regard to quality and incentive elements, systematic comparison showed numerous differences between P4P approaches. Empirical studies showed isolated cost or quality effects, while a simultaneous examination of these effects was missing. Conclusion Research results show that experiences with pay-for-performance approaches in ophthalmology are limited. Identified approaches differ with regard to quality and incentive elements restricting comparability. Two empirical studies are insufficient to draw strong conclusions about the effectiveness and efficiency of these approaches.

This study provides an estimation of pay-4-performance (P4P) rates that energy providers are willing to offer in a P4P scheme in EU according to the classification of Energy efficiency measures (classes of EEMs). Seven different categories of EEMs are identified and 4 different tables for evaluating the EEMs are devised. After devising the classes of EEMs, the P4P rate concept is presented through the mechanism of the Energy Efficiency obligation schemes and considering the energy providers’ perspective. The proposed approach is not focused on quantifying the P4P rates, but on identifying which variables and parameters can affect these rates.

Abstract: Aim: To compare drug recovery outcomes in commissioning areas included in a ‘payment by results’ scheme with all other areas. Design: Observational and data linkage study of the National Drug Treatment Monitoring System, Office for National Statistics mortality database and Police National Computer criminal records, for 2 years before and after introduction of the scheme. Pre–post controlled comparison compared outcomes in participating versus non‐participating areas following adjustment for drug use, functioning and drug treatment status. Setting: Drug services in England providing publicly funded, structured treatment. Participants: Adults in treatment (between 2010 and 2014): 154 175 (10 716 in participating areas, 143 459 non‐participating) treatment journeys in the 2 years before and 148 941 (10 012 participating, 138 929 non‐participating) after the introduction of the scheme. Intervention: Scheme participation, with payment to treatment providers based on patient outcomes versus all other areas. Measurements: Rate of treatment initiation; waiting time (> or < 3 weeks); treatment completion; and re‐presentation; substance use; injecting; housing status; fatal overdose; and acquisitive crime. Findings: In participating areas, there were relative decreases in rates of: treatment initiation [difference‐in‐differences odds ratio (DID OR) = 0.17, 95% confidence interval (CI) = 0.14, 0.21]; treatment completion (DID OR = 0.60, 95% CI = 0.53, 0.67); and treatment completion without re‐presentation (DID OR = 0.63, 95% CI = 0.52, 0.77) compared with non‐participating areas. Within treatment, relative abstinence (DID OR = 1.50, 95% CI = 1.30, 1.72) and non‐injecting (DID OR = 1.32, 95% CI = 1.10, 1.59) rates were improved in participating areas. No significant changes in mortality, recorded crime or housing status were associated with the scheme. Conclusion: Drug addiction recovery services in England that are commissioned on a payment‐by‐results basis tend to have lower rates of treatment initiation and completion but higher rates of in‐treatment abstinence and non‐injecting than other services. [ABSTRACT FROM AUTHOR]

Background: To identify, characterize and compare existing pay-for-performance approaches and their impact on the quality of care and efficiency in ophthalmology.Methods: A systematic evidence-based review was conducted. English, French and German written literature published between 2000 and 2015 were searched in the following databases: Medline (via PubMed), NCBI web site, Scopus, Web of Knowledge, Econlit and the Cochrane Library. Empirical as well as descriptive articles were included. Controlled clinical trials, meta-analyses, randomized controlled studies as well as observational studies were included as empirical articles. Systematic characterization of identified pay-for-performance approaches (P4P approaches) was conducted according to the "Model for Implementing and Monitoring Incentives for Quality" (MIMIQ). Methodological quality of empirical articles was assessed according to the Critical Appraisal Skills Programme (CASP) checklists.Results: Overall, 13 relevant articles were included. Eleven articles were descriptive and two articles included empirical analyses. Based on these articles, four different pay-for-performance approaches implemented in the United States were identified. With regard to quality and incentive elements, systematic comparison showed numerous differences between P4P approaches. Empirical studies showed isolated cost or quality effects, while a simultaneous examination of these effects was missing.Conclusion: Research results show that experiences with pay-for-performance approaches in ophthalmology are limited. Identified approaches differ with regard to quality and incentive elements restricting comparability. Two empirical studies are insufficient to draw strong conclusions about the effectiveness and efficiency of these approaches. [ABSTRACT FROM AUTHOR]

Payment for Performance (P4P) aims to improve provider motivation to perform better, but little is known about the effects of P4P on accountability mechanisms. We examined the effect of P4P in Tanzania on internal and external accountability mechanisms. We carried out 93 individual in-depth interviews, 9 group interviews and 19 Focus Group Discussions in five intervention districts in three rounds of data collection between 2011 and 2013. We carried out surveys in 150 health facilities across Pwani region and four control districts, and interviewed 200 health workers, before the scheme was introduced and 13 months later. We examined the effects of P4P on internal accountability mechanisms including management changes, supervision, and priority setting, and external accountability mechanisms including provider responsiveness to patients, and engagement with Health Facility Governing Committees. P4P had some positive effects on internal accountability, with increased timeliness of supervision and the provision of feedback during supervision, but a lack of effect on supervision intensity. P4P reduced the interruption of service delivery due to broken equipment as well as drug stock-outs due to increased financial autonomy and responsiveness from managers. Management practices became less hierarchical, with less emphasis on bureaucratic procedures. Effects on external accountability were mixed, health workers treated pregnant women more kindly, but outreach activities did not increase. Facilities were more likely to have committees but their role was largely limited. P4P resulted in improvements in internal accountability measures through improved relations and communication between stakeholders that were incentivised at different levels of the system and enhanced provider autonomy over funds. P4P had more limited effects on external accountability, though attitudes towards patients appeared to improve, community engagement through health facility governing committees remained limited. Implementers should examine the lines of accountability when setting incentives and deciding who to incentivise in P4P schemes. [ABSTRACT FROM AUTHOR]

The Quality and Outcomes Framework (QOF) is a Pay-for-Performance scheme introduced in England in 2004 to reward primary care providers. This incentive scheme provides financial incentives that reward the overall performance of a practice, not individual effort. Consequently, an important question is how the QOF may affect contractual choices, quality provision and doctor mobility in the primary healthcare labour market. The paper provides a simple theoretical model that shows that the introduction and further strengthening of the scheme may have induced practices to compete for the best doctors and modified their choices in terms of contractual agreements with practitioners. We test the implications of this model using a linkage between Doctors Census data and practices' characteristics from 2003 to 2007. We use linear multilevel models with random intercept and we account for sample selection. We find that after the introduction of the QOF efficient doctors are more likely to become partners and mobility among doctors has increased. The strengthening of the scheme in 2005 is associated with an increase in the quality of primary care and a reduction in access to the market for new doctors. [ABSTRACT FROM AUTHOR]

The paper studies the short-run and long-run effects of the introduction of a team-oriented Pay-for-Performance, P4P, payment scheme when agents may differ in their degree of intrinsic motivation toward the job. Suppose that new potential employees were able to assess the expected pay-offs of current workers. Then they may modify their approach to work in order to follow the employee type that earned the highest expected pay-off. We show that the definition of the scheme needs to take into consideration the effects produced on the evolution of the motivation of new generations. In particular the desirability and success of a P4P scheme strongly depend on the way incentives are allocated to the members of a team, on the power of the quality-related financial incentive and on the economic and social context in which the scheme is introduced. The analysis is in part motivated by the introduction in UK in 2004 of a P4P scheme for family practitioners in the UK (Quality and Outcomes Framework, QOF) and of a new system of assessing the quality of academic research completed in 2014 (Research Excellence Framework, REF). [ABSTRACT FROM AUTHOR]

Background: Pay-for-performance (P4P) models are intended to promote quality of care in both hospitals and primary care settings. They are considered as a means of changing medical practices, particularly in primary care., Objectives: The first objective of this study was to assess how performance indicators changed over time, measured through "Remuneration on Public Health Objectives" (ROSP) scores, between 2017 and 2020 in a large French region (Grand Est region), and to compare this evolution in the rural vs. urban areas of the region. The second objective was to focus on the area with the least improvement in ROSP scores and to investigate whether the scores and the available sociodemographic characteristics of the area were associated., Methods: First, we measured the evolution over time of P4P indicators (i.e., ROSP scores) obtained from the regional health insurance system, for GP practices in the Grand Est region between 2017 and 2020. We then compared the scores between the Aube Department and the rest of the region (urban areas). To address the second objective, we focused on the area found to have the least improvement in indicators to investigate whether there was a relationship between ROSP score and sociodemographic characteristics., Results: More than 40,000 scores were collected. We observed an overall improvement in scores over the study period. The urban area (Grand Est region minus the Aube) scored better than the rural area (Aube) for chronic disease management [median 0.91 (0.84-0.95) vs. 0.90(0.79-0.94), p < 0.001] and prevention [median 0.36 (0.22-0.45) vs. 0.33 (0.17-0.43), p < 0.001], but not for efficiency, where the rural area (Aube) performed better [median 0.67(0.56-0.74) vs. 0.69 (0.57-0.75 in the rest of the Grand Est region, p = 0.004]. In the rural area, we found no significant association between ROSP scores and sociodemographic characteristics, except for extreme rurality in some sub-areas., Conclusions: At the regional level, the overall improvement in scores observed between 2017 and 2020 suggests that the implementation of ROSP indicators have improved the quality of care, particularly in urban areas. These results also suggest that efforts should be focused on rural areas, which already had the lowest scores at the start of the P4P program., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Sanchez, Sanchez, Bouazzi, Peillard, Ohl-Hurtaud and Quantin.)

In order to achieve the purpose of positioning the target point from any camera photos, for information on how to use the least get the coordinates of the target point in space, based on the the camera imaging model, geometric constraints of the fixed point in space, and the basic principles of the coordinate system transformation, this paper obtained a target point positioning method through uncalibrated photographs similar to P4P. This method could calculate the three-dimensional world coordinates of the target point by observing two images' position coordinates of four points whose world coordinate was already known. Very minimal information was needed in this method, and it could be used with any cameras of photos. Experiment has been made to verify the feasibility of the algorithm. The accuracy compared to traditional calibration methods has no significant losses, and is higher than other self-calibration positioning methods. [ABSTRACT FROM AUTHOR]

Background: Pay-for-performance (P4P) intents to stimulate both more effective and more efficient health care delivery. To date, evidence on whether P4P itself is an efficient method has not been systematically analyzed. Objective: To identify and analyze the existing literature regarding economic evaluation of P4P. Data sources: English, German, Spanish, and Turkish language literature were searched in the following databases: Business Source Complete, the Cochrane Library, Econlit, ISI web of knowledge, Medline (via PubMed), and PsycInfo (January 2000-April 2010). Study selection: Articles published in peer-reviewed journals and describing economic evaluations of P4P initiatives. Full economic evaluations, considering costs and consequences of the P4P intervention simultaneously, were the prime focus. Additionally, comparative partial evaluations were included if costs were described and the study allows for an assessment of consequences. Both experimental and observational studies were considered. Results: In total, nine studies could be identified. Three studies could be regarded as full economic evaluations, and six studies were classified as partial economic evaluations. Based on the full economic evaluations, P4P efficiency could not be demonstrated. Partial economic evaluations showed mixed results, but several flaws limit their significance. Ranges of costs and consequences were typically narrow, and programs differed considerably in design. Methodological quality assessment showed scores between 32% and 65%. Conclusion: The results show that evidence on the efficiency of P4P is scarce and inconclusive. P4P efficiency could not be demonstrated. The small number and variability of included studies limit the strength of our conclusions. More research addressing P4P efficiency is needed. [ABSTRACT FROM AUTHOR]

Pay-for-performance (P4P) initiatives attempt to drive quality of care by aligning desired care processes and outcomes with reimbursement. P4P schemes have emerged at a time of great concern about safety and quality in health care and in the face of a growing nurse shortage. This article discusses the state of the literature linking structures for providing nursing care, measures of process heavily favored in P4P initiatives, and patient outcomes and outlines how P4P is expected to affect nursing practice. It also presents directions for managing practice settings to cope with P4P and for steering nursing's involvement in this area of health policy. As implementation broadens, it remains to be seen whether unintended consequences emerge or whether nurses are successful in using the programs and the data sets that result from them to justify investments in nursing services and solidify the profession's position. [ABSTRACT FROM AUTHOR]

Pay-for-performance is being applied at the physician level to stimulate improvements in quality of care and cost efficiency; however, little is known about how physicians will respond. We interviewed physicians exposed to a financial incentive program in California to identify possible barriers to the successful application of financial incentives by exploring physicians’ opinions of and experiences with pay-for-performance programs. Reasons physicians cited for quality deficiencies included insurance coverage limitations and lack of patient compliance, time, and proper physician oversight. Physicians believe that they play a significant role and have a moderate to high degree of control over quality of care and that it is important to self-monitor. Physicians expressed the need for accurate and timely data, peer comparisons, and more patient time, staff support, and consultations with colleagues to successfully monitor and deliver quality care. Many support increased pay for delivering high-quality care but question measurement accuracy, bonus payment financing, and health plan involvement. [ABSTRACT FROM PUBLISHER]

Gainsharing is a pay for performance model particularly applicable to the anesthesia group-hospital relationship. Recent regulatory action combined with the popularity of the pay for performance (“P4P”) movement signal this is the time to consider potential ways to increase income through gainsharing deals. [Copyright &y& Elsevier]

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• We evaluated the impact of World Food Programme (WFP)'s Purchase for Progress pilot on smallholders' welfare and investment outcomes. • We estimated these effects using panel data obtained from Ethiopian smallholders. • We used an entropy balancing and difference-in-difference (DID) models to identify the effects. • We found that the intervention has raised consumption, investment in child education and asset holding among smallholders. • We also found evidence of elite capture within Farmer Organizations. Agricultural commodity markets in developing countries often operate in a constrained environment of prohibitive transaction costs. Consequently, smallholder farmers are only partly integrated into these markets, a situation that keeps them in a lower level of development equilibrium (poverty trap). Although cooperative institutional alternatives such as Farmers' Organizations (FOs) may reduce transaction costs and revitalize agricultural production and commercialization, they rarely have been successful in fully delivering on these promises. Against this backdrop, the World Food Programmed (WFP) has recently implemented a multi-year and multi-country pilot to increase smallholder participation in commodity markets. The projects involved investing in physical and human capacities of Farmer Organizations (FOs) to aggregate commodities and add value, as well as locally purchasing food aid from the same. The combination of interventions was expected to increase the relative price of agricultural products, particularly staple crops. In this study, using Ethiopian panel survey data, we estimated the causal income and investment effects of the Ethiopian P4P intervention among smallholders. Using an entropy balancing (EB) model and semi-parametric difference-in-difference (DID) model, we show that the P4P intervention has increased per capita consumption by smallholders. Our additional analysis confirms that this effect is heterogeneous owing to elite capture within Farmer Organizations. We also find evidence of increased food consumption scores, increased investments in child schooling, and increased asset holding among program-participating smallholders relative to comparison farmers. Policy implications are discussed. [ABSTRACT FROM AUTHOR]

• The Monitoring System can address the problem of subgrade settlement. • The key technologies are the centering algorithm and pose estimation algorithm. • The camera and target relative position are changed because of train vibration. • The feature-points target and p4p method can estimate the relative position. • The incorrect data can be clear away timely from this monitoring system. In order to improve the measurement accuracy of subgrade settlement deformation system, this study proposes a high-precision, online monitoring system for subgrade settlement imaging. Firstly, the working principle and key technologies of this system are introduced. Secondly, a pose measurement system is designed to solve the problem that the relative position of target and camera in the monitoring system is affected by train vibration, and attitude estimation method p4p(Perspective 4 Points) for rectangular four-feature points target is proposed. Finally, experimental results indicate that when the relative deflection angle is less than 2°, the rotation angle error of pose measurement method in this study is less than 0.09°. The measurement accuracy of this method meets the requirement of this online monitoring system. And on-site testing results illustrate that the monitoring system corrected by the pose measurement system avoids the detection of non-real subgrade settlement and improves the measurement accuracy. [ABSTRACT FROM AUTHOR]

Objective: This study was conducted to investigate the challenges faced in the implementation of the pay-for-performance system in Iran's family physician program., Study Design: Qualitative., Place and Duration of Study: The study was conducted with 32 key informants at the family physician program at the Tabriz University of Medical Sciences between May 2018 and June 2018. Method: This is a qualitative study. A purposeful sampling method was used with only one inclusion criterion for participants: five years of experience in the family physician program. The researchers conducted 17 individual and group non-structured interviews and examined participants' perspectives on the challenges faced in the implementation of the pay-for-performance system in the family physician program. Content analysis was conducted on the obtained data., Results: This study identified 7 themes, 14 sub-themes, and 46 items related to the challenges in the implementation of pay-for-performance systems in Iran's family physician program. The main themes are: workload, training, program cultivation, payment, assessment and monitoring, information management, and level of authority. Other sub-challenges were also identified., Conclusion: The study results demonstrate some notable challenges faced in the implementation of the pay-for-performance system. This information can be helpful to managers and policymakers., (© Academy of Family Physicians of Malaysia.)

Background: Pay-for-performance (P4P) has become a popular approach to increase effectiveness and efficiency in healthcare. So far, there is little evidence regarding the potential of P4P in the German healthcare setting. The aim of this study was to determine the impact of P4P on the quality of care in cataract surgery., Methods: In 2012, a P4P program was implemented in a German surgical centre for ophthalmology. Five quality measures regarding process quality, outcomes, and patient satisfaction were measured over a period of 4.5 years. The P4P scheme consisted of bonus and penalty payments accounting for five per cent of total compensation. Overall, 1657 P4P cases were examined and compared with 4307 control cases. Interrupted time series and group comparisons were conducted to identify quality and spill-over effects., Results: We found a positive impact on process quality and patient satisfaction before the implementation of the P4P scheme, but declining trends during and after the implementation. Our findings did not show an impact of P4P on outcome measures. Furthermore, P4P did not result in better quality of care, compared with the German hospital-based reimbursement scheme., Conclusion: This study did not show any positive long-term effects of the implementation of P4P on quality of care. Therefore, our results do not support the hypothesis that P4P leads to significant improvements in quality of care., (Copyright © 2018 Elsevier B.V. All rights reserved.)