Family Doctor Responses to Changes in Incentives for Influenza Immunization under the <scp>U.K.</scp> Quality and Outcomes Framework Pay‐for‐Performance Scheme

Kontopantelis, Evangelos; Doran, Tim; Gravelle, Hugh; Goudie, R. Ian; Siciliani, Luigi; Sutton, Matt

doi:10.1111/j.1475-6773.2011.01362.x

Cited by 42 publications

(69 citation statements)

References 18 publications

(19 reference statements)

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“…We identified seven cohort studies, one prospective 21 and six retrospective, [22][23][24][25][26][27] and one simulation study. 28 Three included studies 25,26,28 examined threshold changes in the QOF, and found that quality continued to increase after increases in maximum thresholds, with lower-performing providers improving significantly more than those who were performing at a high level under the previous threshold.…”

Section: Implementation Processes (8 Studies)mentioning

confidence: 99%

“…28 Three included studies 25,26,28 examined threshold changes in the QOF, and found that quality continued to increase after increases in maximum thresholds, with lower-performing providers improving significantly more than those who were performing at a high level under the previous threshold. 25,26 In addition, we identified three studies examining clinical process, and patient outcome incentives were removed from a measure. One study, of the QOF, found that the level of performance achieved prior to the incentive withdrawal was generally maintained, with some difference by indicator and disease condition.…”

Section: Implementation Processes (8 Studies)mentioning

confidence: 99%

“…Eight studies [21][22][23][24][25][26][27][28] examined changes in implementation, with seven specifically related to updating or retiring measures, and found:…”

Section: Implementation Processesmentioning

confidence: 99%

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Implementation Processes and Pay for Performance in Healthcare: A Systematic Review

et al. 2016

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BACKGROUND: Over the last decade, various pay-forperformance (P4P) programs have been implemented to improve quality in health systems, including the VHA. P4P programs are complex, and their effects may vary by design, context, and other implementation processes. We conducted a systematic review and key informant (KI) interviews to better understand the implementation factors that modify the effectiveness of P4P. METHODS: We searched PubMed, PsycINFO, and CINAHL through April 2014, and reviewed reference lists. We included trials and observational studies of P4P implementation. Two investigators abstracted data and assessed study quality. We interviewed P4P researchers to gain further insight. RESULTS: Among 1363 titles and abstracts, we selected 509 for full-text review, and included 41 primary studies. Of these 41 studies, 33 examined P4P programs in ambulatory settings, 7 targeted hospitals, and 1 study applied to nursing homes. Related to implementation, 13 studies examined program design, 8 examined implementation processes, 6 the outer setting, 18 the inner setting, and 5 provider characteristics. Results suggest the importance of considering underlying payment models and using statistically stringent methods of composite measure development, and ensuring that high-quality care will be maintained after incentive removal. We found no conclusive evidence that provider or practice characteristics relate to P4P effectiveness. Interviews with 14 KIs supported limited evidence that effective P4P program measures should be aligned with organizational goals, that incentive structures should be carefully considered, and that factors such as a strong infrastructure and public reporting may have a large influence. DISCUSSION: There is limited evidence from which to draw firm conclusions related to P4P implementation. Findings from studies and KI interviews suggest that P4P programs should undergo regular evaluation and should target areas of poor performance. Additionally, measures and incentives should align with organizational priorities, and programs should allow for changes over time in response to data and provider input.

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Section: Implementation Processes (8 Studies)mentioning

confidence: 99%

Section: Implementation Processes (8 Studies)mentioning

confidence: 99%

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Implementation Processes and Pay for Performance in Healthcare: A Systematic Review

et al. 2016

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“…160 This assumption was based on vaccination rates of 50% and between 80% and 93% reported in Spanish and UK studies. 161,162 The average number of days and cost of home oxygen therapy received in each severity group was derived from expert opinion reported in Hertel et al (2012). 140 Smoking-cessation advice and pulmonary rehabilitation are also recommended by NICE as usual care for COPD patients.…”

Section: Routine Health-care Visitsmentioning

confidence: 99%

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

Dretzke

Blissett

Dave

et al. 2015

Health Technol Assess

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BackgroundChronic obstructive pulmonary disease (COPD) is a chronic progressive lung disease characterised by non-reversible airflow obstruction. Exacerbations are a key cause of morbidity and mortality and place a considerable burden on health-care systems. While there is evidence that patients benefit from non-invasive ventilation (NIV) in hospital during an acute exacerbation, evidence supporting home use for more stable COPD patients is limited. In the UK, domiciliary NIV is considered on health economic grounds in patients after three hospital admissions for acute hypercapnic respiratory failure.ObjectiveTo assess the clinical effectiveness and cost-effectiveness of domiciliary NIV by systematic review and economic evaluation.Data sourcesBibliographic databases, conference proceedings and ongoing trial registries up to September 2014.MethodsStandard systematic review methods were used for identifying relevant clinical effectiveness and cost-effectiveness studies assessing NIV compared with usual care or comparing different types of NIV. Risk of bias was assessed using Cochrane guidelines and relevant economic checklists. Results for primary effectiveness outcomes (mortality, hospitalisations, exacerbations and quality of life) were presented, where possible, in forest plots. A speculative Markov decision model was developed to compare the cost-effectiveness of domiciliary NIV with usual care from a UK perspective for post-hospital and more stable populations separately.ResultsThirty-one controlled effectiveness studies were identified, which report a variety of outcomes. For stable patients, a modest volume of evidence found no benefit from domiciliary NIV for survival and some non-significant beneficial trends for hospitalisations and quality of life. For post-hospital patients, no benefit from NIV could be shown in terms of survival (from randomised controlled trials) and findings for hospital admissions were inconsistent and based on limited evidence. No conclusions could be drawn regarding potential benefit from different types of NIV. No cost-effectiveness studies of domiciliary NIV were identified. Economic modelling suggested that NIV may be cost-effective in a stable population at a threshold of £30,000 per quality-adjusted life-year (QALY) gained (incremental cost-effectiveness ratio £28,162), but this is associated with uncertainty. In the case of the post-hospital population, results for three separate base cases ranged from usual care dominating to NIV being cost-effective, with an incremental cost-effectiveness ratio of less than £10,000 per QALY gained. All estimates were sensitive to effectiveness estimates, length of benefit from NIV (currently unknown) and some costs. Modelling suggested that reductions in the rate of hospital admissions per patient per year of 24% and 15% in the stable and post-hospital populations, respectively, are required for NIV to be cost-effective.LimitationsEvidence on key clinical outcomes remains limited, particularly quality-of-life and long-term (> 2 years) effects. Economic modelling should be viewed as speculative because of uncertainty around effect estimates, baseline risks, length of benefit of NIV and limited quality-of-life/utility data.ConclusionsThe cost-effectiveness of domiciliary NIV remains uncertain and the findings in this report are sensitive to emergent data. Further evidence is required to identify patients most likely to benefit from domiciliary NIV and to establish optimum time points for starting NIV and equipment settings.Future work recommendationsThe results from this report will need to be re-examined in the light of any new trial results, particularly in terms of reducing the uncertainty in the economic model. Any new randomised controlled trials should consider including a sham non-invasive ventilation arm and/or a higher- and lower-pressure arm. Individual participant data analyses may help to determine whether or not there are any patient characteristics or equipment settings that are predictive of a benefit of NIV and to establish optimum time points for starting (and potentially discounting) NIV.Study registrationThis study is registered as PROSPERO CRD42012003286.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…Primary care physicians and pediatricians should be more actively involved and be given greater responsibilities in increasing vaccination coverage rates. Incentives to primary care physicians and pediatricians, when deemed strategic, 15 should be conditional to population-level coverage targets rather than to the number of vaccines administrated; 8. It is of fundamental importance to address the growing phenomenon of the 'vaccine hesitancy'.…”

mentioning

confidence: 99%

The future of immunization policies in Italy and in the European Union: The Declaration of Erice

Odone

Fara

Giammaco

et al. 2015

Human Vaccines & Immunotherapeutics

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Family Doctor Responses to Changes in Incentives for Influenza Immunization under the U.K. Quality and Outcomes Framework Pay‐for‐Performance Scheme

Cited by 42 publications

References 18 publications

Implementation Processes and Pay for Performance in Healthcare: A Systematic Review

Implementation Processes and Pay for Performance in Healthcare: A Systematic Review

The cost-effectiveness of domiciliary non-invasive ventilation in patients with end-stage chronic obstructive pulmonary disease: a systematic review and economic evaluation

The future of immunization policies in Italy and in the European Union: The Declaration of Erice

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