Pay for Quality

More documents

Recommendations

Info

50 Pay for Quality KCE Reports 118 • The use of interviews or surveys to check awareness of the programme and to assess acceptability 178 , 180 , 184 , 195 , to assess satisfaction 206 . • The use of interviews or surveys to check measurement activities and how the data are used to maintain or improve the quality of care 210 , reverse feedback about local guideline implementation efforts 197 . • The use of interviews or surveys to identify barriers impeding target attainment 182 . • The use of focus groups for similar purposes 222 . • The use of constant reminders of measures and targets, directly integrated into daily practice 222 . • The presentation of further improvement recommendations towards the participants 210 , the use of suggestions on how to spend earned incentive payments 201 . • Tools and resources provided to support quality improvement, directed at directors and quality improvement teams 175 . Whereas the level of awareness of the programme was acceptable in some studies 180 , a low level was found in other studies 183 , 184 . One study reports a general misunderstanding by participants of contra indications which could be used to exclude patients 181 . Another study identified an initial reaction of suspicion and distrust, disbelieve, being surprised by low baseline scores, a confrontation with poor documentation, which stimulated protocol development, outreach calls, enrolment in disease management programmes, new monitoring and follow-up assignments to staff, and the beginning of utilization of other not incentivized checklists 222 . A number of studies report that P4Q programme participation was of a voluntary nature 44 , 69 , 174 , 175 , 176 , 195 , 205 , 206 , 211 . Other studies do not specify the mandatory versus voluntary design option. On the basis of the complete programme reporting it can sometimes be assumed that participation was obligatory. However, this assumption should be treated with caution when reviewing results. 4.2.5.3 Australia, Germany, Italy, and Spain One Australian study states that the attitudes among participants have generally been positive, with high degrees of compliance and cooperation 213 . The second Australian study makes use of a survey to identify barriers and reasons for not accomplishing targets 214 . No information on implementation and communication was provided in the German study 216 . In the Italian study, work plans and targets were set by regional health authorities 217 , without further specifications on implementation and communication. The Spanish study surveyed the level of job satisfaction of participants and their quality of professional life, using standardized instruments 218 . The results are included in the effects reporting section 4.3.1 (see page 54).
KCE Reports 118 Pay for Quality 51 Key points on implementation and communication United Kingdom • A first attempt to implement a P4Q programme in the mid-1980’s, was rejected by the professionals, partly because physicians rejected the assumption that quality could be measured. With the introduction of evidence based medicine, the health culture changed. • In a second attempt to implement a P4Q programme, which leaded to the implementation of QOF in 2004, the government decided to provide a substantial increase in health care funding and negotiations took place between government and professionals with the assistance of a small group of academic drivers. Participation in the QOF programme is voluntary. USA • Implementation and communication support is provided in one or more ways, depending on the programme. They include mainly involvement of providers/peers, involvement of patients, office staff and educators, leadership support or the use of a small core work group. In addition there has been made use of interviews or surveys, focus groups, reminders and presentations to communicate and implement the programme. The level of awareness of the programme varied between programmes as well as the acceptance. Participation was generally voluntary, although it can be assumed that some programmes are obligatory. Australia, Germany, Italy and Spain • Communication and implementation differed according to the P4Q programme. In some countries a multidisciplinary committee developed the programme, in other countries the targets and work plans were set by the (local) government. 4.2.6 Existing and concurrent quality improvement initiatives Existing and concurrent quality improvement initiatives, both on a local and/or system’s level, have an influence on the primary outcome measures as indicators of quality of care. Therefore, when reviewing the effects of P4Q these trends and co interventions should be taken into account. 4.2.6.1 United Kingdom Generally, a trend of quality improvement can be identified in primary care in the UK. This trend was already set into motion before the introduction of the QOF incentive programme in 2004. A number of system wide quality improvement initiatives introduced before and during the UK P4Q interventions have contributed to positive effects in quality performance. The following main categories can be distinguished: • Changes in standard medical practice in terms of clinical diagnosis and treatment. Examples are the acceleration of the immunization schedule (at a younger age) 132 , the introduction of child health surveillance 125 , a trend of increasing use of effective blood pressure and cholesterol lowering therapy 151 145 , the introduction of nicotine addiction treatment on prescription , and the introduction of a more active screening for cardiovascular risks in diabetes patients 141 . In more general terms, national guidelines and service frameworks have been implemented for hypertension, angina, cardiac rehabilitation, stroke, etc. 126 , 143, 145 , 167 . • Structural changes in the system of healthcare provision: o Changes in setting/infrastructure: the introduction of nurse led primary care diabetes clinics 128 , the introduction of a network of stop smoking services 145 , service redesign such as managed clinical networks for stroke and coronary heart disease (CHD) 126 .
Page 1 and 2:
Voordelen, nadelen en haalbaarheid
Page 3 and 4:
Voordelen, nadelen en haalbaarheid
Page 5 and 6:
Externe validatoren : Simpson (Univ
Page 7 and 8:
KCE Reports 118A Pay for Quality ii
Page 9 and 10:
KCE Reports 118A Pay for Quality iv
Page 11 and 12:
KCE Reports 118A Pay for Quality vi
Page 13 and 14: KCE Reports 118A Pay for Quality vi
Page 15 and 16: KCE Reports 118 Pay for Quality 1 S
Page 17 and 18: KCE Reports 118 Pay for Quality 3 9
Page 19 and 20: KCE Reports 118 Pay for Quality 5 W
Page 21 and 22: KCE Reports 118 Pay for Quality 7 S
Page 23 and 24: KCE Reports 118 Pay for Quality 9 2
Page 25 and 26: KCE Reports 118 Pay for Quality 11
Page 63: KCE Reports 118 Pay for Quality 49
Page 77 and 78: Clinical domain (disease) KCE Repor
Page 115 and 116:
KCE Reports 118 Pay for Quality 101
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191:
Page 194 and 195:
Wettelijk depot : D/2008/10.273/50
Page 196 and 197:
37. HTA Magnetische Resonantie Beel
Page 198:
108. Tiotropium in de behandeling v
show all

Pay for Quality

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?