{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T14:33:24Z","timestamp":1793716404919,"version":"4.6.1"},"reference-count":37,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001547","name":"China Medical Board","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001547","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,4,29]]},"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Many strategies have been either used or recommended to promote physician compliance with clinical practice guidelines and clinical pathways (CPs). This study examines the relationship between hospitals\u2019 use of financial incentives to encourage physician compliance with CPs and physician adherence to CPs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospectively cross-sectional study of the relationship between the extent to which patient care was consistent with CPs and hospital\u2019s use of financial incentives to influence CP compliance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Eighteen public hospitals in three provinces in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Stratified sample of 2521 patients discharged between 3 January 2013 and 31 December 2014.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>The proportion of key performance indicators (KPIs) met for patients with (1) community-acquired pneumonia (pneumonia), (2) acute myocardial infarction (AMI), (3) acute left ventricular failure (heart failure), (4) planned caesarean section (C-section) and (5) gallstones associated with acute cholecystitis and associated cholecystectomy (cholecystectomy).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The average implementation rate of CPs for five conditions (pneumonia, AMI, heart failure, C-section and cholecystectomy) based on 2521 cases in 18 surveyed hospitals was 57% (ranging from 44% to 67%), and the overall average compliance rate for the KPIs for the five conditions was 69.48% (ranging from 65.07% to 77.36%). Implementation of CPs was associated with greater compliance within hospitals only when hospitals adopted financial incentives directed at physicians to promote compliance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CPs are viewed as important strategies to improve medical care in China, but they have not been widely implemented or adhered to in Chinese public hospitals. In addition to supportive resources, education\/training and better administration in general, hospitals should provide financial incentives to encourage physicians to adhere to CPs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-027540","type":"journal-article","created":{"date-parts":[[2019,5,29]],"date-time":"2019-05-29T08:26:38Z","timestamp":1559118398000},"page":"e027540","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Relationship between physician financial incentives and clinical pathway compliance: a cross-sectional study of 18 public hospitals in China"],"prefix":"10.1136","volume":"9","author":[{"given":"Jie","family":"Bai","sequence":"first","affiliation":[{"name":"Hospital Management, School of Public Health, Fudan University, Shanghai, China"},{"name":"CHC Key Lab of Health Technology Assessment (Fudan University), Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Bundorf","sequence":"additional","affiliation":[{"name":"Health Research and Policy, School of Medicine, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Bai","sequence":"additional","affiliation":[{"name":"Technological Guidance, National Center for Medical Service Administration, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiqin","family":"Tang","sequence":"additional","affiliation":[{"name":"Medical Administration, Health Commission of Hubei Province, Wuhan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9210-2383","authenticated-orcid":false,"given":"Di","family":"Xue","sequence":"additional","affiliation":[{"name":"Hospital Management, School of Public Health, Fudan University, Shanghai, China"},{"name":"CHC Key Lab of Health Technology Assessment (Fudan University), Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,5,28]]},"reference":[{"key":"2025121512233291000_9.5.e027540.1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-014-0652-8"},{"key":"2025121512233291000_9.5.e027540.2","unstructured":"NHC. 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