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 .
Public reporting improves antibiotic prescribing for upper respiratory tract infections in primary care: a matched-pair cluster-randomized trial in China
Background Inappropriate use and overuse of antibiotics is a serious concern in the treatment of  upper respiratory tract infections ( URTIs )  , especially in developing countries . In recent decades , information disclosure and public reporting ( PR ) has become an instrument for encouraging good practice in healthcare . This study evaluated the impact of PR on antibiotic prescribing for URTIs in a sample of primary care institutions in China . Methods A matched-pair cluster-r and omized trial was undertaken in QJ city , with 20 primary care institutions participating in the trial . Participating institutions were matched into pairs before being r and omly assigned into a control and an intervention group . Prescription statistics were disclosed to patients , health authorities , and health workers monthly within the intervention group , starting from October 2013 . Outpatient prescriptions for URTIs were collected from both groups before ( 1st March to 31st May , 2013 ) and after the intervention ( 1st March to 31st May , 2014 ) . A total of 34,815 URTI prescriptions were included in a difference-in-difference analysis using multivariate linear or logistic regression models , controlling for patient attributes as well as institutional characteristics . Results Overall , 90 % URTI prescriptions required antibiotics and 21 % required combined use of antibiotics . More than 77 % of URTI prescriptions required intravenous ( IV ) injection or infusion of drugs . PR result ed in a 9 percentage point ( 95 % CI -17 to -1 ) reduction in the use of oral antibiotics ( adjusted RR = 39 % , P = 0.027 ) , while the use of injectable antibiotics remained unchanged . PR led to a 7 percentage point reduction ( 95 % CI -14 to 0 ; adjusted RR = 36 % ) in combined use of antibiotics ( P = 0.049 ) , which was largely driven by a significant reduction in male patients ( -7.5 % , 95 % CI -14 to -1 , P = 0.03 ) . The intervention had little impact on the use of IV injections or infusions , or the total prescription expenditure . Conclusions The results suggest that PR could improve prescribing practice s in terms of reducing oral antibiotics and combined use of antibiotics ; however , the impacts were limited . We suggest that PR would probably be enhanced by provider payment reform , management and training for providers , and health education for patients
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 .