The evidence is concentrated in two types of PMM strategies : implementation strategies ( in-service training , continuing education , supervision ) and performance-based financing .
Major gaps exist in accountability arrangements particularly the use of audit and feedback .
The least studied types of outcomes were unintended effects , harm and social equity .
Conclusions The evidence is clustered around interventions that are unlikely to achieve transformational change in health outcomes .
The gaps identified suggest that routinely used PMM strategies are implemented without sufficient knowledge of their effects .
Introduction We mapped available evidence on  performance measurement and management ( PMM ) strategies in primary healthcare ( PHC ) systems of low-income and middle-income countries ( LMICs ) .
Widely used , their effectiveness remains inconclusive .
This evidence gap map characterises existing research and evidence gaps .
Effects and cost-effectiveness of a guideline-oriented primary healthcare hypertension management program in Beijing, China: results from a 1-year controlled trial
Hypertension control rates are unacceptably low in China . The present study demonstrates if a customized , guideline -oriented training program can cost-effectively improve hypertension management in primary healthcare . Four typical community health centers in Beijing were selected and r and omized to intervention or control ( one urban and one rural each ) . A sample of 140 patients with hypertension and blood pressure uncontrolled was recruited from each center . Primary healthcare providers in intervention centers provided management to the recruited patients for 1 year after receiving training with customized hypertension management guidelines , and primary healthcare providers in control provided with usual care . Intention-to-treat analysis showed that hypertension control ( systolic blood pressure ( SBP ) < 140 mm Hg and diastolic blood pressure ( DBP ) < 90 mm Hg ) ) rate was significantly higher in interventions than controls at month 3 ( 42.1 % vs. 34.3 % in urban and 30.7 % vs. 10.0 % in rural centers ) and the trend increased to month 12 ( 70.7 % vs. 40.0 % in urban and 72.9 % vs. 27.9 % in rural ) ; P-values by logistic mixed model were all < 0.001 for both urban and rural after adjustment for baseline multiple variables including blood pressure . Mean reductions of SBP and DBP were significantly larger in interventions . The intervention was cost-saving , with an average incremental cost-saving of US$ 20.3 per patient in urban sites and $ 7.0 per patient in rural sites . Corresponding results from per- protocol analysis were very similar . The customized , guideline -oriented hypertension management program in primary healthcare in China effectively improved blood pressure control and was cost-saving
The evidence is concentrated in two types of PMM strategies : implementation strategies ( in-service training , continuing education , supervision ) and performance-based financing .
Major gaps exist in accountability arrangements particularly the use of audit and feedback .
The least studied types of outcomes were unintended effects , harm and social equity .
Conclusions The evidence is clustered around interventions that are unlikely to achieve transformational change in health outcomes .
The gaps identified suggest that routinely used PMM strategies are implemented without sufficient knowledge of their effects .
Introduction We mapped available evidence on  performance measurement and management ( PMM ) strategies in primary healthcare ( PHC ) systems of low-income and middle-income countries ( LMICs ) .
Widely used , their effectiveness remains inconclusive .
This evidence gap map characterises existing research and evidence gaps .