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 .
Depression care management for adults older than 60 years in primary care clinics in urban China: a cluster-randomised trial.
BACKGROUND China 's national health policy classifies depression as a chronic disease that should be managed in primary care setting s. In some high-income countries use of chronic disease management principles and primary care-based collaborative-care models have improved outcomes for late-life depression ; however , this approach has not yet been tested in China . We aim ed to assess whether use of a collaborative-care depression care management ( DCM ) intervention could improve outcomes for Chinese adults with depression aged 60 years and older . METHODS Between Jan 17 , 2011 , [ corrected ] and Nov 30 , 2013 , we did a cluster-r and omised trial in patients from primary care centre clinics in Shangcheng district of Hangzhou city in eastern China . We r and omly assigned ( 1:1 ) clinics to either DCM ( involving training for physicians in use of treatment guidelines , training for primary care nurses to function as care managers , and consultation with psychiatrists as support ) or to give enhanced care as usual to all eligible patients aged 60 years and older with major depressive disorder . Clinics were chosen r and omly for inclusion from all primary care clinics in the district by computer algorithm and then r and omly allocated depression care interventions remotely by computer algorithm . Physicians , study personnel , and patients were not masked to clinic assignment . Our primary outcome was difference in Hamilton Depression Rating Scale ( HAMD ) score using data for clusters at baseline and 3 , 6 , and 12 month follow-up in a mixed-effects model of the intention-to-treat population . We originally aim ed to analyse outcomes at 24 months , however the difference between groups at 12 months was large and funding was insufficient to continue to 24 months , therefore we decided to end the trial at 12 months . This trial is registered with Clinical Trials.gov , number NCT01287494 . FINDINGS Of 34 primary care clinics in Shangcheng district , 16 were r and omly chosen . We r and omly assigned eight clinics to the DCM intervention ( 164 patients enrolled ) and eight primary care clinics to enhanced care as usual ( 162 patients ) . There were no major differences in baseline demographic and clinical variables between the groups of patients for each intervention . Over the 12 months , patients in clinics assigned to DCM had a significantly greater reduction in HAMD score than did those in practice s assigned to enhanced care as usual ( estimated between group difference -6·5 [ 95 % CI -7·1 to -5·9 ] ; Cohen 's d 0·8 [ 95 % CI 0·8 - 0·9 ] ; p<0·0001 ) . The intercluster correlation for change in HAMD total score was 0·07 ( 95 % CI 0·06 - 0·08 ) . There were no study -related adverse events in either group . INTERPRETATION Clinical outcomes of Chinese adults older than 60 years who had major depression were improved when their primary care clinic used DCM . Primary care-based collaborative management of depression is promising to address this pressing public health need in China . FUNDING National Institutes of Health , Program for New Century Excellent Talents in Universities of China , Ministry of Education , China
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 .