Risk of Care Home Placement following Acute Hospital Admission: Effects of a Pay-for-Performance Scheme for Dementia

Abstract

IntroductionThe Quality and Outcomes Framework, or QOF, rewards primary care doctors (GPs) in the UK for providing certain types of care. Since 2006, GPs have been paid to identify patients with dementia and to conduct an annual review of their mental and physical health. During the review, the GP also assesses the carer’s support needs, including impact of caring, and ensures that services are co-ordinated across care settings. In principle, this type of care should reduce the risk of admission to long-term residential care directly from an acute hospital ward, a phenomenon considered to be indicative of poor quality care. However, this potential effect has not previously been tested.MethodsUsing English data from 2006/07 to 2010/11, we ran multilevel logit models to assess the impact of the QOF review on the risk of care home placement following emergency admission to acute hospital. Emergency admissions were defined for (a) people with a primary diagnosis of dementia and (b) people with dementia admitted for treatment of an ambulatory care sensitive condition. We adjusted for a wide range of potential confounding factors.ResultsOver the study period, 19% of individuals admitted to hospital with a primary diagnosis of dementia (N = 31,120) were discharged to a care home; of those admitted for an ambulatory care sensitive condition (N = 139,267), the corresponding figure was 14%. Risk factors for subsequent care home placement included older age, female gender, vascular dementia, incontinence, fall, hip fracture, and number of comorbidities. Better performance on the QOF review was associated with a lower risk of care home placement but only when the admission was for an ambulatory care sensitive condition.ConclusionsThe QOF dementia review may help to reduce the risk of long-term care home placement following acute hospital admission.

Investigating the impact of primary care payments on underdiagnosis in dementia: A difference‐in‐differences analysis

“…12,13,25,26 In our study, both DES18 and the DIS schemes appeared effective. However, the targeting of financial incentives on GPs in order to achieve quality improvements underpins the major policy initiative of the QOF programme.…”

“…Since 2006, the QOF has incentivised good quality care for people with dementia, primarily via a face-to-face annual review [11][12][13] and requires practices to maintain a dementia register. The schemes were facilitated by a separate pay-for-performance scheme, the Quality and Outcomes Framework (QOF).…”

“…The schemes were facilitated by a separate pay-for-performance scheme, the Quality and Outcomes Framework (QOF). Since 2006, the QOF has incentivised good quality care for people with dementia, primarily via a face-to-face annual review [11][12][13] and requires practices to maintain a dementia register. We measured the schemes' effectiveness in tackling underdiagnosis by the gap between the "reported" (recorded) and "expected" numbers on practices' QOF dementia registers.…”

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“…It has been axiomatic for some time in healthcare research that a rapidly ageing population, and a corollary growth in the numbers of individuals suffering from dementia, has been causing a progressive range of structural/distributional problems for many frontline public and private healthcare services (Iliffe, Wilcock, & Haworth, 2006;Kasteridis et al, 2016).…”