Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study

Abstract

Objective To estimate the impact of a national primary care pay for performance scheme, the Quality and Outcomes Framework in England, on emergency hospital admissions for ambulatory care sensitive conditions (ACSCs).Design Controlled longitudinal study.Setting English National Health Service between 1998/99 and 2010/11. Participants Populations registered with each of 6975 family practices in England.Main outcome measures Year specific differences between trend adjusted emergency hospital admission rates for incentivised ACSCs before and after the introduction of the Quality and Outcomes Framework scheme and two comparators: non-incentivised ACSCs and non-ACSCs.Results Incentivised ACSC admissions showed a relative reduction of 2.7% (95% confidence interval 1.6% to 3.8%) in the first year of the Quality and Outcomes Framework compared with ACSCs that were not incentivised. This increased to a relative reduction of 8.0% (6.9% to 9.1%) in 2010/11. Compared with conditions that are not regarded as being influenced by the quality of ambulatory care (non-ACSCs), incentivised ACSCs also showed a relative reduction in rates of emergency admissions of 2.8% (2.0% to 3.6%) in the first year increasing to 10.9% (10.1% to 11.7%) by 2010/11. ConclusionsThe introduction of a major national pay for performance scheme for primary care in England was associated with a decrease in emergency admissions for incentivised conditions compared with conditions that were not incentivised. Contemporaneous health service changes seem unlikely to have caused the sharp change in the trajectory of incentivised ACSC admissions immediately after the introduction of the Quality and Outcomes Framework. The decrease seems larger than would be expected from the changes in the process measures that were incentivised, suggesting that the pay for performance scheme may have had impacts on quality of care beyond the directly incentivised activities.

Desigualdades intraurbanas de taxas de internações por condições sensíveis à atenção primária na região central do Brasil

“…Kidney and urinary tract infections were the third most common cause of admissions. These findings are consistent with the findings described in the literature, which show that rates of admissions for ACSCs are higher among this age group 5,7,[49][50][51][52] . The most prevalent conditions among the 60 years and over age group were circulatory system diseases, the most common of which were heart failure, angina and cerebrovascular diseases.…”

A population-based analysis of incentive payments to primary care physicians for the care of patients with complex disease

“…39 Most research in this area focuses on care for individual diseases, using the delivery of specific services as indicators of quality. 24,[30][31][32][33][34] Evidence of the effect of incentive-based programs on broader outcomes such as access to primary care, continuity of care, 40 hospital admissions [25][26][27][28][29]41,42 and overall resource use 30,34,43 has been inconclusive.…”

“…In studies of the UK Quality and Outcomes Framework, in which incentives were directly tied to measured quality of care, any observed decreases in hospital admissions accompanying observed changes in quality were small, [25][26][27] and some studies found no association between measured quality and hospital admissions. 28,29 Research to date, largely from the United Kingdom and United States, has provided mixed evidence of the effectiveness of these programs.…”

Care and Do Not Harm: Possible Misunderstandings With Quaternary Prevention (P4) Comment on "Quaternary Prevention, an Answer of Family Doctors to Over Medicalization"

“…A shift in research agenda from disease specific research to research based on global impact in overall health (functional impairment), seems necessary with the increase of multimorbidity. 18 This research should not be based only on biomedical or numerical indices (such as hospitalization rate 19 ). A special emphasis should be left to qualitative research 20 to assess the impact of health policies, evaluating the lived experience of practitioners and users (for example anthropological studies after implementation of a new payment system 21,22 ) (Table).…”