Pay for Quality

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 .