Background: Both Health Technology Assessment (HTA) and Performance Management (PM) are clinical governance disciplines that aim to improve the quality, equity, and financial sustainability of health organizations and systems. Although HTA and PM share many features, to the authors' knowledge, few studies have investigated their interplay. This study attempts to fill this gap by analysing how the literature has explored and developed the integration between HTA and PM concepts and tolls within healthcare sector. Methods: To address this gap, this study examines 33 papers selected through a scoping review that explores the inter of HTA and PM within the healthcare sector. In particular, the paper adopted the preferred reporting items for systematic reviews and meta-analysis (PRISMA) methodology to select and analyse articles. Results: The review highlights the dynamic convergence of HTA and PM, emphasizing how combining these frameworks and functions can enhance decision-making in healthcare. This integration ensures that technologies are adopted on the basis of proven effectiveness in pursuing healthcare systems goals and that performance metrics align with evidence-based practices, leading to better resource allocation and improved patient outcomes. The literature review underscores the need for further research to understand the integration between HTA and PM and their combined impact on organizational performance, sustainability, and resilience in the healthcare sector. Conclusion: This study contributes to the literature by providing a comprehensive overview of the current state of research on HTA and PM, offering insights for future studies, and practical recommendations for integrating these disciplines to improve healthcare management and policymaking.

Background Private equity (PE) investment in U.S. nursing homes has increased significantly over the past two decades. The emergence of this novel ownership model has prompted concerns regarding its effects on nursing home performance, especially quality. Objective This systematic review examined the impact of PE ownership on U.S. nursing homes, focusing on quality of care and financial performance. The review was conceptually informed by agency theory and the structure-process-outcome (SPO) framework. Methods Following PRISMA guidelines, a systematic search across five databases identified 12 studies published between 2000 and 2024. Eligible studies examined the effects of PE ownership on nursing home quality or financial performance. Data were extracted and synthesized across these two dimensions. Results Across studies, PE ownership was linked to higher number of deficiencies, increased hospitalization rates, and higher mortality, although some improvements in care processes were noted. Financial outcomes showed initial financial gains but long-term challenges, primarily due to high debt loads. Conclusions Findings suggest that PE strategies may prioritize short-term profitability, which may compromise quality of care in some instances. These findings highlight the need for financial transparency, and reimbursement models that incentivize long-term quality.

Background As hospitals expand their roles within transforming health systems, their governance structures must adapt to changing demands, with novel leadership structures evolving to meet new challenges. Objective This review aims to provide a comprehensive overview on the evidence of the influence of hospital C-level positions on key organisational performance parameters. It maps key concepts from the existing literature relating to hospital performance and leadership and identifies mediators and moderators of top management team impacts based on the Upper-Echelons-Theory. Methods The scoping review was conducted according to the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, covering studies from 1990 to the present. Eligible studies addressed at least one identifiable hospital C-Suite role and one hospital-wide leadership effect. Results Out of 5,430 articles identified, 60 were included. The analysis covers seven distinct C-Suite roles and their effects on six performance dimensions: quality of care, structural quality, patient satisfaction, work satisfaction, financial performance, and process efficiency. Conclusions The findings suggest that the influence of C-Suite positions on hospital performance is multifaceted, with the Chief Executive Officer's influence extending beyond financial performance to shaping the quality of care. Additionally, the impact of newer roles such as the Chief Quality Officer, as well as leadership roles like the Chief Medical Officer and Chief Nursing Officer, appear to depend on a collaborative approach and alignment with the Chief Executive Officer. From a policy perspective, the findings emphasise that hospital governance, shaped by regulations, determines key performance indicators and strategic priorities.

Abstract Background: As hospitals expand their roles within transforming health systems, their governance structures must adapt to changing demands, with novel leadership structures evolving to meet new challenges. Objective: This review aims to provide a comprehensive overview on the evidence of the influence of hospital C-level positions on key organisational performance parameters. It maps key concepts from the existing literature relating to hospital performance and leadership and identifies mediators and moderators of top management team impacts based on the Upper-Echelons-Theory. Methods: The scoping review was conducted according to the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, covering studies from 1990 to the present. Eligible studies addressed at least one identifiable hospital C-Suite role and one hospital-wide leadership effect. Results: Out of 5430 articles identified, 60 were included. The analysis covers seven distinct C-Suite roles and their effects on six performance dimensions: quality of care, structural quality, patient satisfaction, work satisfaction, financial performance, and process efficiency. Conclusions: The findings suggest that the influence of C-Suite positions on hospital performance is multifaceted, with the Chief Executive Officer's influence extending beyond financial performance to shaping the quality of care. Additionally, the impact of newer roles such as the Chief Quality Officer, as well as leadership roles like the Chief Medical Officer and Chief Nursing Officer, appear to depend on a collaborative approach and alignment with the Chief Executive Officer. From a policy perspective, the findings emphasise that hospital governance, shaped by regulations, determines key performance indicators and strategic priorities.

Objective: By studying the Technology-Organization-Environment Framework (TOE), this research explores the impact of various indicators in technology, organization, and environment on the performance of family doctor services during major public health emergencies. It aims to identify the driving paths to improve performance. Methods: A stratified sampling of 34 community health service centers in Shanghai was conducted, using the comprehensive performance score of family doctors as the outcome variable. The Average Internet Medical Service Person-times and the Information Technology Expenditure per Thousand Population were considered as technology-related variables. The Fiscal Allocation per Thousand Population (/1,000), the Family Doctor Team Members per Thousand Population, and the Medical Social Workers and Volunteers per Thousand Population were identified as organization-related variables. The Proportion of Older Adult Population, Fiscal Allocation per Thousand Population, and the number of patient self-education organizations per thousand population were taken as environment-related variables. Fuzzy-set Qualitative Comparative Analysis (fsQCA) was employed to conduct necessity analysis, truth table analysis, and configurational analysis of antecedent conditions, with robustness tests performed by adjusting consistency thresholds and case frequencies. Results: The study found that the performance of family doctor services was influenced by multiple factors, with no single decisive factor. In overall communities, five configurations, including per capita fiscal allocation and community participation, affected performance, explaining 4.2% of the variance. In central urban areas, information technology expenditure and the Proportion of Older Adult Population were core conditions, influencing 27.5% of performance paths. In non-central urban areas, core conditions such as financial support and IT covered 53.9% of data cases. The fsQCA results, which were robustly tested, begin to provide a strong basis for resource allocation and policy formulation. Conclusion: This study begins to fill the gap in research on family doctor service performance during major public health emergencies, exploring the synergistic effects and causal asymmetry among multiple indicators such as technology, organization, and environment from a holistic, or configurational, perspective.

Abstract Effective diabetes management can prevent avoidable diabetes-related hospitalizations. This review examines the impact of financial incentives for diabetes management in primary care settings on diabetes-related hospitalizations, hospitalization costs, and premature mortality. To assess the evidence, we conducted a literature search of studies using five databases: Medline, Embase, Scopus, CINAHL and Web of Science. We examined the results by health insurance system, study quality or diabetes population (newly diagnosed diabetes). We identified 32 articles ranging from fair- to high-quality: 19 articles assessed the relationship between financial incentives for diabetes management and hospitalizations, 8 assessed hospitalization costs, and 15 assessed mortality. Many studies found that financial incentives for diabetes management reduced hospitalizations, while a few found no effects. Similar findings were evident for hospitalization costs and mortality. The results did not differ by the type of health insurance system, but the quality of the studies did matter; most high-quality studies reported reduced hospitalizations and/or mortality. We also found that financial incentives tend to be beneficial for patients with newly diagnosed diabetes. We conclude that well-designed diabetes management incentives can reduce diabetes-related hospitalizations, especially for newly diagnosed diabetes patients.

OBJECTIVE: To analyze the role played by the clinical pharmacist and its impact in antibiotic stewardship facing suspected allergy to beta-lactam antibiotics. METHOD: We performed 2 different independent bibliographic searches. A total of 35 articles were found, and the final number included in the study was 12. We analyzed the articles and collected variables of efficacy, safety, and applicability of evaluation tools applied to patients with suspected allergy to beta-lactams. Also, the variation in the consumption and prescription profile of alternative antibiotics was analyzed. RESULTS: The selected studies analyzed questionnaires, allergy delabeling, intradermal tests, and oral challenge tests performed by pharmacists. Significant differences in the efficacy endpoint were found in 4 studies in favor of pharmaceutical intervention. In the study of Kwiatkowski et al., cefazolin use increased in surgical patients after pharmacist intervention (65% vs 28%; P < .01). In a quasi-experimental study, the mean defined daily dose of aztreonam and the mean days of therapy per 1000 patients/day decreased (21.23 vs 9.05, P <.01) and (8.79-4.24, P = .016), pre- and post-intervention, respectively, increasing antibiotic de-escalations (P = < .01). In another quasi-experimental study, the prescription of restricted use antibiotics decreased (42.5% vs 17.9%, P < .01) and the use of pre-surgical prophylactic antibiotics alternative to cefazolin (81.9% vs 55.9%, P < .01) in another study. Other study showed that the mean time per interview was 5.2 min per patient. No adverse events were reported in any study. CONCLUSION: The pharmacist intervention in the evaluation of the patient with suspected allergy to beta-lactams is effective, safe, and feasible to implement on daily clinical practice. The standardization of protocols to clarify the history of allergies and development of evaluation tools represent simple screenings to perform delabeling or refer to the Immunoallergology service, improving penicilins use and reducing the need for second-line antibiotics. More studies are needed to standardize the desensitization tests made by pharmacists. However, despite these results, the involvement and leadership of the pharmacist in this area is limited and constitutes a future challenge for the profession.

Introduction: Health workers in rural and remote areas shoulder heavy responsibilities for rural residents. This systematic review aims to assess the effectiveness of continuing education programs for health workers in rural and remote areas.Methods: Eight electronic databases were searched on 28 November 2021. Randomized controlled trials (RCTs) and quasi -experimental studies evaluating the effectiveness of continuing education for health workers in rural and remote areas were included. The quality of the studies was assessed using the risk of bias tool provided by Effective Practice and Organization of Care. A meta-analysis was performed for eligible trials, and the other findings were presented as a narrative review because of inconsistent study types and outcomes. Results: A total of 17 studies were included, four of which were RCTs. The results of the meta-analysis showed that compared to no intervention, continuing education programs significantly improved the knowledge awareness rate of participants (odds ratio=4.09, 95% confidence interval 2.51-6.67, p<0.05). Qualitative analysis showed that 12 studies reported on the level of knowledge of participants, with all showing positive changes. Eight studies measured the performance of health workers in rural and remote areas, with 87.50% (n=7) finding improved performance. Two studies reported on the impact of continuing education programs for health workers in rural and remote areas on patient health, with only one showing a positive change. One study from India measured the health of communities, which showed a positive change.Conclusion: The results of this study showed that continuing education programs are an effective way to address the lack of knowledge and skills among health workers in rural and remote areas. Few studies have examined the effectiveness of education programs for health workers in rural and remote areas in improving patient health outcomes. It is not yet known whether the delivery of continuing education programs to health workers in rural areas has a positive impact on patient and community health. Future attention should continue to be paid to the impact on these outcomes.

The systematic use of patient-reported measures (PRMs) [i.e., patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs)] is advocated as an effective way to improve care practices. However, whether PRMs can lead to the performance assessment of healthcare organisations (HCOs) through valid quality indicators (QIs) for national purposes (i.e., public reporting and paying for performance) is open to debate. This study undertakes a scoping review to examine the use of PRMs as QIs for health policy purposes and to identify the challenges faced in the emblematic case of oncology. According to PRISMA guidelines, published papers, websites and reports published by national and international initiatives were analysed using five online databases (Web of Science, Scopus, PubMed, JSTOR and Google Advanced Search), and then studied using the same keywords. We selected 61 articles and 19 websites/reports and identified 29 PREMs and 48 PROMs from 14 countries and two international initiatives that routinely used them as QIs for HCOs’ comparisons. Four types of barriers to this specific use were identified relating to the definition of a standard set, scientific soundness, data collection, and the actionability of such measures. Despite current developments, different barriers still must be overcome before PRMs can be used for health policy purposes in oncology. Future research is needed to ensure that valid QIs related to PRMs are applied at a national level.

The global rise in deaths caused by pulmonary tuberculosis (TB) has placed increased pressure on overburdened healthcare systems to provide TB diagnostic services. Artificial intelligence-based computer-aided diagnosis (AI-based CAD) promises to be a powerful tool in responding to this health challenge by providing actionable outputs which support the diagnostic accuracy and efficiency of clinicians. However, these technologies must first be extensively evaluated to understand their impact and risks before pursuing wide-scale deployment. Yet, health technology assessments for them in real world settings have been limited. Comprehensive evaluation demands consideration of technical safety, human factors, and health impacts to generate robust evidence and understand what is needed for long-term sustainable benefit realisation. This work-in progress study presents a three-stage methodological approach that will be used to guide the data collection and analysis process for evaluating the impact of implementing a commercial AI-based CAD system for TB diagnosis in a real-world radiological setting.

In response to rising costs and growing concerns about safety, quality, equity and affordability of health care, many countries have now developed and deployed performance-based incentives, targeted at facilities as well as individuals. Evidence of the effect of these efforts has been mixed; it remains unclear how effective strategies of varying design and magnitude (relative to provider salary) are at incentivizing individual-level performance. This study reviews the current evidence on effectiveness of individual-level performance-based incentives for health care in Organisation for Economic Co-operation and Development countries, which are relatively well situated to implement, monitor and evaluate performance-based incentives programs. We delineate the conditions under which sanctions or rewards – in the context of gain-seeking, loss aversion, and increased social pressure to modify behaviors – may be more effective. We find that programs that utilized positive reinforcement methods are most commonly observed – with slightly more overall bonus incentives than payment per output or outcome achieved incentives. When comparing the outcomes from negative reinforcement methods with positive reinforcement methods, we found more evidence that positive reinforcement methods are effective at improving health care worker performance. Overall, just over half of the studies reported positive impacts, indicating the need for care in designing and adopting performance-based incentives programs.

Hospitals in today's healthcare system are under pressure to boost their competi-tiveness. A number of studies have shown the disconnect between corporate culture and the enhancement of healthcare profes-sionals' performance. While it is well accepted that an organization's culture has a substantial impact on the performance of its health care professionals in clinical prac-tice, the mechanisms by which culture might enhance health care professionals' performance remain unclear. This paper draws on 22 literature reviews and database searches using keyword syntax from Sciencedirect, Pubmed, Google Schoolar, and other relevant publications published between 2011 and 2021. Research in the field demonstrates that a company's culture may influence the efficiency and effective-ness of its healthcare employees. This over-arching issue was dissected into the follow-ing themes: nurse performance mediated by discipline; the existence of cultural groups; a central focus on health care professional management; and individual, organization-al, and psychological aspects. The optimal performance of nurses and the outcomes of patient care are contingent on management in the health care business knowing the cul-tural factors that exist in the workplace. health-care professionals are confronted with the need to enhance the competitive- ness of hospitals, which necessitates the exploitation of human resources.1 Considering that at least 30-40 percent of patients do not receive treatment based on scientific evidence and that 20 percent or more of health care provided is either unneeded or may cause harm to the patient, this assertion is reasonable.2 Integration of research into clinical practice is frequently advocated as a way of improving perfor- mance, addressing unexpected variation in individual physician decision-making, and improving patient and system outcomes. While the application of research findings to practice is frequently advocated as a solution, statistics such as those given above demonstrate that there is a misalign- ment between corporate culture and health care professional performance improve- ment efforts.2 This divide between theory and practice is essentially a failure of corporate culture to motivate health care professional to achieve at their highest levels. Understanding and addressing organiza- tional culture issues requires a thorough understanding of a variety of factors, such as practitioner obstacles, the environment in which choices are made, and transforma- tional impediments.3 To far, the majority of nursing research has been devoted to deter- mining the impact of doing research at the person rather than organizational level. A comprehensive assessment of the individual drivers of improved health care professional performance discovered minimal consisten- cy in study findings addressing the individ- ual variables that predicted better health care professional performance via organiza- tional culture.4 Additionally, when studying individual factors (e.g., age, gender, years of nursing experience), researchers generally look at irreversible determinants (e.g. age, gender, years of nursing experience). Given the fact that the vast majority of healthcare profes- sionals work in complex organizations, this shift in emphasis toward examining the organizational factors that influence research use is critical.5 However, little is known regarding the effect of organization- al culture on health care professional perfor- mance improvement. As part of an ongoing initiative exploring how health care profes- sional choose their research use, we did a review of the literature on nursing organiza- tional culture studies to ascertain the status of the science. The goal of this essay in its whole is to: ascertain the organizational cul- ture elements that influence health care pro- fessional performance.

目的系统梳理新一轮医药卫生体制改革以来农村基本医疗卫生服务综合评价指标体系,基于PHCPI概念框架(primary health care performance initiative conceptual framework)探寻目前评价指标普遍关注的内容和可能被忽略的评价内容,为后续科学、全面地评价农村基本医疗卫生服务提供参考依据。方法通过中国知网、万方数据知识服务平台、维普中文科技期刊数据库检索2009—2019年有关农村基本医疗卫生服务综合评价指标体系的文献,基于SPIDER规范制定纳入排除标准,采用批判评估技术方案对纳入文献进行质量评价,运用框架合成法,选取PHCPI概念框架对纳入的文献进行归纳和总结。结果共纳入25篇文献,总体质量良好。评价体系中的指标可分为5个一级领域、16个二级领域、24个三级领域指标。综合对比各领域对应指标的文献数,卫生资金、效率等领域对应指标的文献数较多,均有20篇左右的文献,高于其他多数领域;投入、产出和结果的相应领域中,近85%的领域对应指标的文献在15篇及以上;服务提供的各领域中,仅18%左右的领域对应指标的文献达到15篇,40%以上领域对应指...

Background Mild cognitive impairment (MCI) is a cognitive state falling between normal aging and dementia. The relation between alcohol intake and risk of MCI as well as progression to dementia in people with MCI (PDM) remained unclear. Objective To synthesize available evidence and clarify the relation between alcohol intake and risk of MCI as well as PDM. Method We searched electronic databases consisting of PubMed, EMBASE, Cochrane Library, and China Biology Medicine disc (CBM) from inception to October 1, 2019. Prospective studies reporting at least three levels of alcohol exposure were included. Categorical meta-analysis was used for quantitative synthesis of the relation between light, moderate and heavy alcohol intake with risk of MCI and PDM. Restricted cubic spline and fixed-effects dose-response models were used for dose-response analysis. Result Six cohort studies including 4244 individuals were finally included. We observed an unstable linear relation between alcohol intake (drinks/week) and risk of MCI (P linear = 0.0396). It suggested that a one-drink increment per week of alcohol intake was associated with an increased risk of 3.8% for MCI (RR, 1.038; 95% CI 1.002-1.075). Heavy alcohol intake (> 14 drinks/week) was associated with higher risk of PDM (RR = 1.76; 95% CI 1.10-2.82). And we found a nonlinear relation between alcohol intake and risk of PDM. Drinking more than 16 drinks/week (P nonlinear = 0.0038, HR = 1.42; 95% CI 1.00-2.02), or 27.5 g/day (P nonlinear = 0.0047, HR = 1.46; 95% CI 1.00-2.11) would elevate the risk of PDM. Conclusion There was a nonlinear dose-response relation between alcohol intake and risk of PDM. Excessive alcohol intake would elevate the risk of PDM.

Objectives: To examine the association between informal caregiving and caregiver work performance. Method: A systematized review of the literature. Results: We found that caregiving has an adverse impact on work performance: caregivers experience substantial work disruptions and negative work performance outcomes, and these findings were consistent across measures. Our synthesis suggests that caregivers miss a significant amount of work and have reductions in productivity due to their caregiving responsibilities. However, significant methodological limitations with the reviewed studies make systematic interpretations and causal determinations challenging. Discussion: Examining the effect of caregiving on work performance is critical to better understand the full impact of caregiving, especially as demand for caregivers increases as the population ages. This comprehensive review suggests that caregiving has a significant negative impact on work performance, although methodological challenges remain in this area of science. These findings should inform both public policy development and workplace benefits design.

BACKGROUND: Pay for Performance (P4P) mechanisms to health facilities and providers have been implemented in several low- and middle-income countries (LMIC) to improve maternal and child health (MCH). These are tied to predetermined quality and quantity indicators. There is limited synthesized information on the structural, institutional and organizational factors that influence the success of P4P programmes with respect to quality of care. This review, which builds on a previously published review sets out to synthesize existing literature on the factors that influence the outcome of P4P programmes and quality of care. METHODS: A literature review was conducted of published studies documenting implementation of P4P interventions and quality of care in low and middle income countries. Records published between June 2014 and September 2017 were selected and combined with articles from January 1990 to June 2014 previously identified by colleagues. RESULTS: 13 studies were included in the final analysis. The majority of studies found a positive impact on quality of care scores and at least one study showed significant reductions in mortality outcomes in newborns. One study from Afghanistan did not show any positive effects. Structural factors associated with likely success of P4P programmes included: explicit acceptance and understanding by health workers; limiting the number of indicators measured with inputs from health workers. Organisational factors included sufficient incentive payments. Notably the main positive outcome identified was facility financial autonomy from additional payments. Verification by external assessors revealed no major manipulation to achieve payment trigger levels. The primary institutional factors identified that P4P programmes fared better when introduced alongside other health reforms and increased funding. CONCLUSIONS: This review has found that P4P is not a uniform intervention, but rather a range of approaches with a substantial variation and complexity in how programmes incorporate quality of care considerations. P4P has shown to have an impact on the quality of a number of limited aspects of maternal and child health care. Further research is needed to understand whether additional aspects of the quality of MCH care could be positively influenced by P4P programmes and how health worker motivation and acceptance are linked to this.

BACKGROUND: Although pay-for-performance (P4P) strategies have been used by the Veterans Health Administration (VHA) for over a decade, the long-term benefits of P4P are unclear. The use of P4P is further complicated by the increased use of non-VHA healthcare providers as part of the Veterans Choice Program. We conducted a systematic review and key informant interviews to better understand the effectiveness and potential unintended consequences of P4P, as well as the implementation factors and design features important in both VHA and non-VHA/community settings. METHODS: We searched PubMed, PsycINFO, and CINAHL through March 2017 and reviewed reference lists. We included trials and observational studies of P4P targeting Veteran health. Two investigators abstracted data and assessed study quality. We interviewed VHA stakeholders to gain further insight. RESULTS: The literature search yielded 1031 titles and abstracts, of which 30 studies met pre-specified inclusion criteria. Twenty-five examined P4P in VHA settings and 5 in community settings. There was no strong evidence supporting the effectiveness of P4P in VHA settings. Interviews with 17 key informants were consistent with studies that identified the potential for overtreatment associated with performance metrics in the VHA. Key informants' views on P4P in community settings included the need to develop relationships with providers and health systems with records of strong performance, to improve coordination by targeting documentation and data sharing processes, and to troubleshoot the limited impact of P4P among practices where Veterans make up a small fraction of the patient population. DISCUSSION: The evidence to support the effectiveness of P4P on Veteran health is limited. Key informants recognize the potential for unintended consequences, such as overtreatment in VHA settings, and suggest that implementation of P4P in the community focus on relationship building and target areas such as documentation and coordination of care.

BACKGROUND: Virtual-reality based rehabilitation (VR) shows potential as an engaging and effective way to improve upper-limb function and cognitive abilities following a stroke. However, an updated synthesis of the literature is needed to capture growth in recent research and address gaps in our understanding of factors that may optimize training parameters and treatment effects. METHODS: Published randomized controlled trials comparing VR to conventional therapy were retrieved from seven electronic databases. Treatment effects (Hedge's g) were estimated using a random effects model, with motor and functional outcomes between different protocols compared at the Body Structure/Function, Activity, and Participation levels of the International Classification of Functioning. RESULTS: Thirty-three studies were identified, including 971 participants (492 VR participants). VR produced small to medium overall effects (g = 0.46; 95% CI: 0.33-0.59, p < 0.01), above and beyond conventional therapies. Small to medium effects were observed on Body Structure/Function (g = 0.41; 95% CI: 0.28-0.55; p < 0.01) and Activity outcomes (g = 0.47; 95% CI: 0.34-0.60, p < 0.01), while Participation outcomes failed to reach significance (g = 0.38; 95% CI: -0.29-1.04, p = 0.27). Superior benefits for Body Structure/Function (g = 0.56) and Activity outcomes (g = 0.62) were observed when examining outcomes only from purpose-designed VR systems. Preliminary results (k = 4) suggested small to medium effects for cognitive outcomes (g = 0.41; 95% CI: 0.28-0.55; p < 0.01). Moderator analysis found no advantage for higher doses of VR, massed practice training schedules, or greater time since injury. CONCLUSION: VR can effect significant gains on Body Structure/Function and Activity level outcomes, including improvements in cognitive function, for individuals who have sustained a stroke. The evidence supports the use of VR as an adjunct for stroke rehabilitation, with effectiveness evident for a variety of platforms, training parameters, and stages of recovery.

INTRODUCTION: Despite common assumptions that doctors are well placed to lead hospitals and healthcare organisations, the peer-reviewed literature contains little evidence on the performance of doctors in leadership roles in comparison with that of non-medical managers. OBJECTIVES: To determine whether there is an association between the leader's medical background and management performance in terms of organisational performance or patient outcomes. METHODS: We searched for peer-reviewed, English language studies using Medline, Embase and Emerald Management between 2005 and 2017. We included quantitative, qualitative and mixed method empirical studies on the performance of senior healthcare managers where participants were described as doctors or leaders and where comparative performance data were provided on non-medical leaders. Studies without full text available, or no organisational, leadership behaviour or patient measures, were excluded. RESULTS: The search, conducted in Medline (n=3395), Embase (n=1913) and Emerald Management (n=454) databases, yielded 3926 entries. After the application of inclusion and exclusion criteria, 16 studies remained. Twelve studies found that there were positive differences between medical and non-medical leaders, and eight studies correlated those findings with hospital performance or patient outcomes. Six studies examined the composition of boards of directors; otherwise, there were few common areas of investigation. Five inter-related themes emerged from a narrative analysis: the impact of medical leadership on outcomes; doctors on boards; contribution of qualifications and experience; the medical leader as an individual or part of a team and doctors transitioning into the medical leadership role. DISCUSSION AND CONCLUSION: A modest body of evidence supports the importance of including doctors on organisational governing boards. Despite many published articles on the topic of whether hospitals and healthcare organisations perform better when led by doctors, there were few empirical studies that directly compared the performance of medical and non-medical managers. This is an under-researched area that requires further funding and focus.

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