Pay for Quality

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112 Pay for Quality KCE Reports 118 Primary care 1. Breast cancer screening prevention bonus 2. Capitation funding revaluation in the primary health care centres (MM, WGC) 3. EPA tool 4. Global medical record (DMG/GMD) 5. Prescription feedback of the National council for Quality Promotion (CNPQ/NRKP) 6. Preventive module in global medical record Hospital care 1. Centres of reference 2. Hospital accreditation 3. Hospital benchmarking 4. Quality and Patient Safety Framework for hospitals 5. Reference payment These programmes are presented in a structured tabular format, addressing programme initiation, implementation, target audience, content, primary focus, type of indicators used, purpose of indicators used, type of incentives, results, publications and budget (if publicly available). Table 7: Care itineraries I. CARE ITINERARIES Initiated by RIZIV/INAMI. In 2001 RIZIV/INAMI took the decision to develop specific chronic care programmes, combining the contribution of GP, specialists and other disciplines in a scientific and coordinated way. These transmural programmes were called “Care itineraries / Zorgtrajecten / Trajets de Soins”. From 2003 till 2007, field tests took place in Leuven and Aalst. The practical organization will start from June and September 2009 with two defined care itineraries: on chronic renal failure and diabetes mellitus type 2. Other chronic care fields are envisaged for the future: COPD, Chronic Heart Failure, Frail Elderly, osteoporosis, depression, cancer … Overall objective To reinforce the continuity of care between patient, GP, and specialist and tackle underuse mutually Date of implementation in Belgium June and September, 2009 Target audience Partnership between patient, GP and topic specialist around specified chronic conditions (first itineraries are diabetes and chronic renal insufficiency). Focus is on the patient with chronic conditions. The aim is to optimize the quality of the follow-up, and the outcome parameters, defined for the condition. Individual targets are defined, and an optimum treatment scheme together with an ideal follow up scheme is planned. Supporting disciplines like educators, home nurses and dieticians are brought together in a local primary care team. Local pharmacists are invited to play their role. Content Individual contract with patient (involvement in reaching targets), GP (coordination) and specialist (support, continuing education and updating) Installing local multidisciplinary networks to support professional dealing with chronic conditions. 1. At the individual level, the patient, entering the care-itinerary and declaring to do the best of his/her possibilities, is completely reimbursed for all contacts with their GP and the topic-specialist. Some supporting disciplines are reimbursed following a defined
KCE Reports 118 Pay for Quality 113 Primary focus (structure, process outcome) quality scheme. The GP, as care coordinator, and the specialist for support earn 80€ per patient per year. 2. At the quality content level, the National Council for the Promotion of Quality defined the inclusion and exclusion criteria, the optimal follow up and the average targets in line with international guidelines and options. From 2011 onwards, outcome data will be collected electronically to evaluate the evolution over time, and to judge the impact of the system. 3. At the local multidisciplinary network level regions for implementation of chronic care itineraries will be defined, care managers will be installed, and the local GP’s groups, the local integrated homecare services (GDT/SISD) and the specialists covering the area are brought together. Pilots are contracted for 4 years, and granted 93.000€ per area (between 75 000 and 186 000 inhabitants). Data will be aggregated per local area to support feed back and benchmarking. Reaching individual defined targets (in line with international targets), by a set of processes (minimum obligatory set), supported by rearranging and re-tasking of existing structures adding 2 new functions: the primary care educator and the care itinerary manager Type of indicators used (if any) Set of outcome parameters (from 2011). For the different diseases, some of the crucial targets are considered as quality indicators. For diabetes the choice was made to use HbA1c, systolic BP, LDL cholesterol, and BMI as indicator. With these indicators, the message is strengthened that diabetes is a complex metabolic syndrome that include cardiovascular risk management, and that weight control is important. For Chronic Renal Insufficiency, eGFR, blood pressure, Hb, Creatinin, and parathormone are selected. Purpose of indicators used Evaluate the global programme and provide regional data to networks for benchmarking. Type of incentives Annual supplementary capitation fee (80€) for GP and for SP, no co-payment for patient, defined fee for educator, financial support for local multidisciplinary networks (93 000€/ 125 000 inhabitants). Balanced package of annual care-payments for GP’s and specialist, omitting all financial constraints for patients, enhanced payment for upgrading of home nurses and dieticians as educators, and important introduction of an opportunity for a management function to support primary care as an organizational structure. Results (if available) From 2011 on Sources (most relevant ones) International publications of preparative pilots 2003-2007 in 241, 242 Leuven and Aalst, budget evaluation report end 2009. Total budget €30.7 million
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Wettelijk depot : D/2008/10.273/50
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Pay for Quality

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