Conceptual Issues in the Design and Implementation of Pay-for-Quality Programs

Abstract

This article identifies and discusses key conceptual issues in designing and implementing pay-for-quality programs. Such programs offer financial incentives to providers for achieving predefined quality targets. The purpose of the article is to provide health care professionals with a framework for designing, implementing, and evaluating pay-for-quality programs. Examples are drawn from the Rewarding Results demonstration project for which the authors serve as the national evaluation team.

The Quality and Outcomes Framework and self-management dialogue in primary care consultations: a qualitative study

“…17,28 The study suggests that structures such as current clinical information systems reinforce difficulties: they bring self-management topics into view, but their design does not necessarily address the tensions underpinning selfmanagement support. 16,17,42 The present findings highlight the importance of considering the interactions between the multiple components of care in the Chronic Care Model. 1 Implications for practice and research Current policy has intensified rather than reduced the tensions underpinning selfmanagement support.…”

Using Visual Analytics to Improve Hospital Scheduling and Patient Flow

“…Although access block might be addressed by attending to a number of systemic issues [5], [30], [35], [31], [62], [41], [33], [45], [42], [84], [23], [69] there is an immediate need to improve patient flow within the hospital system. Failure to address this problem potentially jeopardises healthcare services and the health of patients [71], [34], [78], [26], [16], [66], [27], [67].…”

“…In addition to an insufficient number of inpatient beds [2], access block is attributed to limited workforce capacity; an ageing population; the increasing number of young patients (under 25 years) who access EDs as a substitute for primary care [13], [5]; the increasing number of patients requiring intense and/or continued hospital treatment [30], thus overcrowding hospital departments [35]; a decline in community services including nursing homes and mental health services, which in turn adds further strain on the hospital system [31]; changing patient expectations, largely consequent to improved access to health information; changing referral patterns -for instance, 86 percent of patients in the Australian state of New South Wales (NSW) self-refer to EDs; increased use of ambulance services, which has risen by 10 percent annually in the last two years; the limited access of day clinics and private practitioners [62]; the decline in bulk billing among general practitioners [41], [33], [45], [42], particularly in rural areas [84], [23], [69]; and funding arrangements that focus on elective surgery and outpatient care [2].…”

Implementation of pay for performance in primary care: a qualitative study 8 years after introduction

“…26 The initial theoretical concern about pay for performance leading to greater control and surveillance within primary care 27 has been less evident in empirical data. 28,29 While McDonald et al described the notion of 'chasers' and 'chased' within practices when QOF was first introduced, 16 this was not seen as new by the practices themselves or indeed as particularly controlling of clinical autonomy since it was instigated 'in house'. However, GPs in this study talked extensively about micromanagement, from above (usually from the Department of Health), linked to notions of losing control of workload, for example, due to the unpredictable and variable announcement of changes to indicators and the wider QOF each year.…”