Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework

Doran, Tim; Fullwood, Catherine; Kontopantelis, Evangelos; Reeves, David

doi:10.1016/s0140-6736(08)61123-x

Cited by 216 publications

(246 citation statements)

References 16 publications

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“…15,24 Comparison with existing literature The deficiencies in the quality of care received by people with dementia are consistent with previous studies demonstrating suboptimal care received by these patients in secondary and private care settings. [24][25][26][27] Although improved performance in care for individual conditions like diabetes has been apparent in recent years -and since the introduction of the QOF in UK general practice 49,50 -this is not necessarily true for all subgroups of patients. For example, women and ethnic minority groups are less likely to have targets for diabetes met compared with their counterparts.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Connolly

Campbell²,

Gaehl³

et al. 2013

Br J Gen Pract

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BackgroundVascular diseases contribute to the causation and progression of clinical dementia. AimTo evaluate the quality of medical care for vascular diseases provided to people with dementia, the patient and practice characteristics that influence quality, and to compare care with that provided to those without dementia. Design and settingObservational, cross-sectional review of primary care records of people with dementia from 52 general practices from five primary care trusts in the UK, and comparison with publicly available summary data on patients without dementia. MethodA total of 700 patients with ≥1 diagnosed vascular disease or risk factor were identified from dementia registers. Quality of care was measured on 30 indicators from the UK Quality and Outcomes Framework (QOF) for hypertension, coronary heart disease, stroke, diabetes mellitus, atrial fibrillation, heart failure, and smoking. Overall quality of vascular care was calculated for each patient with dementia. ResultsLevel of care received by people with dementia was significantly lower compared with those without dementia for 22 of 30 (73%) indicators; most notably for measurement processes such as peripheral pulses check and neuropathy testing for diabetes, and cholesterol measures for stroke. Among people with dementia, women, those in care homes, and those with fewer comorbid physical conditions and medications were associated with lower scores for overall quality of vascular care. ConclusionThe quality of medical care provided to people with dementia with regard to vascular diseases is not concordant with quality, as defined by the QOF. Research is needed to improve access to high-quality care.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Connolly

Campbell²,

Gaehl³

et al. 2013

Br J Gen Pract

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“…7 Evaluations of the QOF suggest that the scheme may deliver modest improvements in the quality of care, 8 and could help to reduce health inequalities. 9 However, the cost-effectiveness of the QOF has been questioned. 10 Focusing on QOF indicators expected to have a direct therapeutic impact, this research explored the potential cost-effectiveness of this pay-for-performance approach.…”

Section: Introductionmentioning

confidence: 99%

Value for money and the Quality and Outcomes Framework in primary care in the UK NHS

Walker

Mason²,

Claxton³

et al. 2010

Br J Gen Pract

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The Quality and Outcomes Framework (QOF) is a pioneering attempt to improve the quality of primary care in the UK through the use of financial rewards. Despite its achievements, there are concerns that the QOF may offer poor value for money. AimTo assess the cost-effectiveness of QOF payments. Design of studyEconomic analysis. SettingEngland, UK. MethodCost-effectiveness evidence was identified for a subset of nine QOF indicators with a direct therapeutic impact. These data were then applied to an analytic framework to determine the conditions under which QOF payments would be cost-effective. This framework was constructed to assess the costeffectiveness of QOF payments by modelling the incentive structure using cost-effectiveness thresholds of £20 000 and £30 000 per quality-adjusted life year (QALY) gained, to represent good value to the NHS. It used 2004/2005 data on the QOF performance of all English primary care practices. ResultsAverage indicator payments ranged from £0.63 to £40.61 per patient, and the percentage of eligible patients treated ranged from 63% to 90%. The proportional changes required for QOF payments to be cost-effective varied widely between the indicators. Although most indicators required only a fraction of a 1% change to be cost-effective, for some indicators improvements in performance of around 20% were needed. ConclusionFor most indicators that can be assessed, QOF incentive payments are likely to be a cost-effective use of resources for a high proportion of primary care practices, even if the QOF achieves only modest improvements in care. However, only a small subset of the indicators has been considered, and no account has been taken of the costs of administering the QOF scheme. Keywordscost-effectiveness; family practice; health care; physician incentive plans; quality indicators.

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“…A number of studies on service provision in deprived areas point towards older GPs, poorer standards in premises and an increased number of practices without training status (Williams et al, 2004). Practices in deprived areas achieve lower Quality and Outcomes Framework scores in the UK (Ashworth et al, 2007), supporting the view that poorer standards apply in more deprived areas although the gap between affluent and deprived areas appears to be reducing (Doran et al, 2008). Shorter average distances to GP surgeries in more deprived areas may be allied to longer waiting times and possibly poorer quality care.…”

Section: Introductionmentioning

confidence: 99%

The distribution of GPs in Ireland in relation to deprivation

et al. 2010

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The aim of this study was to describe the distribution GP services in Ireland with respect to deprivation. Seven percent of rural inhabitants live within walking distance of the nearest GP compared to 89% of city dwellers. The longest average travel times occur in the most deprived rural areas. The variation in travel times across deprivation scores was modest, particularly in city, town and village areas. The highest workloads were observed in the most deprived urban areas. The current distribution of GPs in Ireland is relatively equitable although the most deprived practices have high workloads or appear to be overstretched. Incentives may be required to increase service provision in these highly deprived areas.

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Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework

Cited by 216 publications

References 16 publications

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Under-provision of medical care for vascular diseases for people with dementia in primary care: a cross-sectional review

Value for money and the Quality and Outcomes Framework in primary care in the UK NHS

The distribution of GPs in Ireland in relation to deprivation

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