Pay-for-Performance Programs in Family Practices in the United Kingdom

Doran, Tim; Fullwood, Catherine; Gravelle, Hugh; Reeves, David; Kontopantelis, Evangelos; Hiroeh, Urara; Roland, Martin

doi:10.1056/nejmsa055505

Cited by 650 publications

(571 citation statements)

References 19 publications

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“…We think that the approach to this huge shortcoming should involve both the GPs and the Health Authorities. A pay-for-performance contract for GPs 13 can significantly increase the BP recording rate, 14 and, on the other hand, solo or group practices can improve their performances adopting simple an unexpensive self auditing procedures. 15 Both approaches could increase the number of patients with recorded BP values and possibly reduce the number of non-attainders, focusing GPs on the need to better motivate and involve their hypertensive patients.…”

Section: Discussionmentioning

confidence: 99%

Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice

Filippi

Paolini

Innocenti³

et al. 2009

J Hum Hypertens

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Blood pressure (BP) control remains unsatisfactory worldwide. Better knowledge of BP management in clinical practice is needed to develop more effective improving strategies. Using a large Italian primary care database, we selected the subjects diagnosed with hypertension, and extracted the diagnosis of myocardial infarction, angina pectoris/coronary disease, stroke/transitory ischemic attack (TIA), heart failure, atrial fibrillation, peripheral arterial disease, diabetes mellitus, the serum total cholesterol, HDL cholesterol, triglycerides, creatinine, BP, electrocardiogram, weight, height and the prescription of cardiovascular (CV)

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Section: Discussionmentioning

confidence: 99%

Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice

Filippi

Paolini

Innocenti³

et al. 2009

J Hum Hypertens

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“…PMs are a postulated tool to help improve health-care quality (21). In the United Kingdom, the National Institute for Health and Clinical Excellence (NICE) guideline implementation strategies use financial and regulatory incentives, including pay-forperformance (35). However, concerns in linking financial incentives to performance exist.…”

Section: Implications For Practice Policy and Researchmentioning

confidence: 99%

Performance Measures in the Management of Chronic Obstructive Pulmonary Disease in Primary Care – A Retrospective Analysis

Kaufmann

Markun

Hasler

et al. 2015

Praxis

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Leistungsmessgrössen in der Grundversorgung von Patienten mit COPD – eine Analyse Zusammenfassung. Hintergrund: Das Befolgen der Empfehlungen für ein gutes Management der chronisch-obstruktiven Lungenkrankheit (COPD) verbessert wichtige Endpunkte. Leistungsmessgrössen (LM) reflektieren die Qualität der Betreuung, dennoch existieren über die Dokumentation dieser Messgrössen bei COPD für die Grundversorgung kaum Daten. Ziel: Überprüfen der Dokumentation von COPD spezifischen Messgrössen in Grundversorgerpraxen des Kanton Zürich. Methode: Retrospektive Auswertung der Krankengeschichten von Patienten mit ärztlich diagnostizierter COPD, über einen Zeitraum von zwölf Monaten. Die Dokumentation der LM wurde durch Berechnen des Prozentsatzes der dokumentierten Parameter bewertet. Zusätzlich erfolgte ein Vergleich der LM Dokumentation mit einer Praxis, die ein strukturiertes COPD-Programm implementiert hatte. Resultate: Es wurden Daten von 115 Patienten aus 14 Praxen, davon 57% männlich, mit einem Durchschnittsalter von 68 (44–93) Jahren, analysiert. 46% waren aktive Raucher mit 56 (22–150 py) Packyears. Komorbiditäten waren in 73% der Fälle dokumentiert, der Schweregrad mit GOLD-Klassifizierung in 70% (GOLD I 11%, GOLD II 64%, GOLD III 21%, GOLD IV 4%).Gemäss Dokumentation hatten die Patienten durchschnittlich 1,4 Exazerbationen pro Jahr. Die Dokumentation der LM lag zwischen 16% (schriftlicher Aktionsplan im Falle von Exazerbationen) und 95% (Raucherstatus). Eine Dokumentation für eine Rauchstopp-Empfehlung fand sich in 74% der Fälle, für die Grippeimpfung in 49%. Eine adäquate medikamentöse Therapie und Instruktion der Inhalation war für 65 bzw. 57%, für pulmonale Rehabilitation in 27% der Patienten dokumentiert. Angaben zu einer kollaborativen und proaktiven Betreuung fanden sich bei 60 resp. 51%. Die Praxis mit dem laufenden COPD-Programm zeigte eine signifikant bessere Dokumentation (p<0,01) für alle LM ausser für die Grippeimpfung. Schlussfolgerung: In der Schweizer Grundversorgung bestehen Lücken in der Dokumentation hinsichtlich der Empfehlungen für eine nutzbringende COPD-Versorgung. Die Identifikation und Überbrückung dieser Lücken ist zentral für mehr Qualität in der Gesundheitsversorgung.

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“…[1][2][3] Of particular note, the Patient Protection and Affordable Care Act (ACA) mandates the adoption of P4P (i.e., value-based purchasing) for hospitals and physicians participating in the Medicare program. Although P4P programs vary markedly in their design, two common features are: 1) defined performance goals for selected quality measures, and 2) associated financial incentives that can be targeted to institutions, individuals or both.…”

Section: Introductionmentioning

confidence: 99%

Sustainability of Quality Improvement Following Removal of Pay-for-Performance Incentives

et al. 2013

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BACKGROUND: Although pay-for-performance (P4P) has become a central strategy for improving quality in US healthcare, questions persist about the effectiveness of these programs. A key question is whether quality improvement that occurs as a result of P4P programs is sustainable, particularly if incentives are removed. OBJECTIVE: To investigate sustainability of performance levels following removal of performance-based incentives. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study that capitalized on a P4P program within the Veterans Health Administration (VA) that included adoption and subsequent removal of performance-based incentives for selected inpatient quality measures. The study sample comprised 128 acute care VA hospitals where performance was assessed between 2004 and 2010. INTERVENTION: VA system managers set annual performance goals in consultation with clinical leaders, and report performance scores to medical centers on a quarterly basis. These scores inform performance-based incentives for facilities and their managers. Bonuses are distributed based on the attainment of these performance goals. MEASUREMENTS: Seven quality of care measures for acute coronary syndrome, heart failure, and pneumonia linked to performance-based incentives. RESULTS: Significant improvements in performance were observed for six of seven quality of care measures following adoption of performance-based incentives and were maintained up to the removal of the incentive; subsequently, the observed performance levels were sustained. LIMITATIONS: This is a quasi-experimental study without a comparison group; causal conclusions are limited. CONCLUSION: The maintenance of performance levels after removal of a performance-based incentive has implications for the implementation of Medicare's value-based purchasing initiative and other P4P programs. Additional research is needed to better understand human and system-level factors that mediate sustainability of performance-based incentives.KEY WORDS: inpatients; physician incentive plans; quality improvement; quality indicators; reimbursement; incentive; salaries ; fringe benefits.

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Pay-for-Performance Programs in Family Practices in the United Kingdom

Cited by 650 publications

References 19 publications

Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice

Blood pressure control and drug therapy in patients with diagnosed hypertension: a survey in Italian general practice

Performance Measures in the Management of Chronic Obstructive Pulmonary Disease in Primary Care – A Retrospective Analysis

Sustainability of Quality Improvement Following Removal of Pay-for-Performance Incentives

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