Exclusion of patients from quality measurement of diabetes care in the UK pay‐for‐performance programme

Dalton, Arh; Alshamsan, Riyadh; Majeed, Azeem; Millett, Christopher

doi:10.1111/j.1464-5491.2011.03251.x

Cited by 32 publications

(51 citation statements)

References 24 publications

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“…We identified 15 retrospective cohort studies 30,[32][33][34][35][36][37][38][39][40][41][42][43][44][45] and three cross sectional surveys 15,46,47 related to the inner setting. Studies of the QOF found that larger practices in the UK performed better in the short term, [33][34][35] particularly when examining total QOF points; 37 however, results varied when examining subgroups by condition or location and by indicator.…”

Section: Inner Setting (18 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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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: Inner Setting (18 Studies)mentioning

confidence: 99%

“…Inner setting Eighteen studies 15,30,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] examined implementation factors related to the inner setting. Studies found:…”

Section: Implementation Processesmentioning

confidence: 99%

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

et al. 2016

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“…Appropriate and permissible exception reporting, however, should exclusively be determined by patient characteristics. Dalton et al (2011) discover significantly higher rates of exception reporting for already disadvantaged patient groups such as older patients and ethnic minorities. In consequence, P4P could lead to greater health disparities since exception reported patients are less likely to achieve treatment targets.…”

Section: Literature Reviewmentioning

confidence: 99%

“…The authors find that non-profit providers of substance abuse treatment in the U.S. treat less severely ill patients and avoid more severe cases in order to improve overall performance. Gravelle et al (2010) and Dalton et al (2011) report gaming of exception reporting under the QOF. Exception reporting is an instrument that allows the exclusion of patients from certain QOF quality indicators based on broad clinical criteria.…”

Section: Literature Reviewmentioning

confidence: 99%

Money Talks - Paying Physicians for Performance

2013

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“…These metrics were adopted from reasonably vetted measures from sources such as the National Quality Forum. Unfortunately, in ESRD, multiple well researched quality measures based on hard outcomes are lacking, such that the measures included in the QIP do not have strong evidence supporting a beneficial effect on important patient outcomes (Table 3) (22)(23)(24)(25)(26)(27)(28).…”

Section: Legislative Pay For Performance: Acos and The Esrd Qipmentioning

confidence: 99%

Comparing Mandated Health Care Reforms

Watnick

Weiner

Shaffer

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryIn addition to extending health insurance coverage, the Affordable Care Act of 2010 aims to improve quality of care and contain costs. To this end, the act allowed introduction of bundled payments for a range of services, proposed the creation of accountable care organizations (ACOs), and established the Centers for Medicare and Medicaid Innovation to test new care delivery and payment models. The ACO program began April 1, 2012, along with demonstration projects for bundled payments for episodes of care in Medicaid. Yet even before many components of the Affordable Care Act are fully in place, the Medicare ESRD Program has instituted legislatively mandated changes for dialysis services that resemble many of these care delivery reform proposals. The ESRD program now operates under a fully bundled, case-mix adjusted prospective payment system and has implemented Medicare's first-ever mandatory pay-for-performance program: the ESRD Quality Incentive Program. As ACOs are developed, they may benefit from the nephrology community's experience with these relatively novel models of health care payment and delivery reform. Nephrologists are in a position to assure that the ACO development will benefit from the ESRD experience. This article reviews the new ESRD payment system and the Quality Incentive Program, comparing and contrasting them with ACOs. Better understanding of similarities and differences between the ESRD program and the ACO program will allow the nephrology community to have a more influential voice in shaping the future of health care delivery in the United States.

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Exclusion of patients from quality measurement of diabetes care in the UK pay‐for‐performance programme

Abstract: Patients excluded from pay-for-performance programmes may be less likely to achieve treatment goals and disproportionately come from disadvantaged groups. Permitting physicians to exclude patients from pay-for-performance programmes may worsen health disparities.

Cited by 32 publications

References 24 publications

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

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

Money Talks - Paying Physicians for Performance

Comparing Mandated Health Care Reforms

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