Pay for Quality

KCE Reports 118 Pay for Quality 55
4.3.1.2 Acute care
Concerning emergency care there is weak evidence of a positive effect on timeliness of
care 213 (H). The effect on timeliness had a range of no effect to a 10% effect depending
on the urgency of care. There was no effect on emergency department – hospital
admission patient flow 213 (H). Finally, there is weak evidence for a positive relationship
with the smoking cessation referral rate in the emergency department 220 (H).
For myocardial infarction/acute cardiac events there is strong evidence of a lack of
effect on the timely administration of thrombolytic agents and of a 5.4% positive effect
on timely percutaneous coronary intervention 175 (H). For most other targets P4Q
effects ranged between zero and 3% 44 , 174 , 175 , 223 (H). The upper limit of this range was
higher for prescribing aspirin at discharge (8.5%) and ACE inhibitor use (9.9%). No
effect was found on not incentivized control measures 174 , 223 (H).
For coronary artery bypass grafting (CABG) patients there is weak evidence on the
absence of effect on various long term outcomes 189 (H). Only a 10% positive effect on
the discharge to home ratio was found 189 (H).
There is strong evidence of a 25.5% positive effect on the provision of discharge
instructions to heart failure patients 175 (H). There is no effect on ACE inhibitor use and
smoking cessation advice 44 , 175 (H). For left ventricular failure (LVF) assessment the
effect ranges from minus 2.4 to plus 5.1% 44 , 175 , 223 (H).
With regard to community acquired pneumonia there is strong evidence of a positive
effect on pneumococcal screening and/or vaccination (9.5-44.7%) and for blood culture
testing (3.5%) 44 , 175 , 223 (H). For oxygenation assessment and timely antibiotics
administration the effect ranged from minus 1.9 and minus 3.2% to zero and plus 4.3% 44
, 175 , 223
(H).
There is weak conflicting evidence concerning three targets focusing on replacing
inappropriate care by evidence based alternatives in the treatment of acute sinusitis (-
29%- 14%) 171 (P&H).
With regard to breastfeeding rate there is weak evidence of a positive effect of P4Q
with a range between 6 and 12% 217 (H). This was mainly due to a shift from partial to
full breastfeeding and not by a higher patient rate beginning with breastfeeding.
4.3.1.3 Chronic care results
Firstly, concerning diabetes for a limited number of targets there is strong evidence of a
positive effect, but with a below 5% effect size: weight recording, smoking status
recording, and peripheral pulses testing 143 (P) Secondly, another group of targets
showed no effect: hypoglycaemic symptoms recording and glycaemia control rate
143, 219
(P). It should be noted that the last target finding is based on weak evidence only. In
addition, for blood pressure recording and influenza immunization there is strong
evidence of no effect, however some studies with a weaker design came to positive
effects 127, 143, 152, 187, 219 (P). Thirdly, a wider effect range, between 0 and 25% is supported
by strong evidence for HbA1c testing rate, lipid and cholesterol testing rate,
nephropathy testing rate and retinal exam rate 69 , 143, 172 , 187 , 190 , 191 , 222 (H&P). Fourthly,
for some targets there is strong evidence of a positive effect with a smaller range:
HbA1c intermediate outcomes (0-14%), cholesterol outcome (positive up to 23.5%),
blood pressure outcome (1.6-6.3%) and foot exam rate (2.7-45%) 74 , 143, 222 (P). For a
number of other targets only weak evidence was available. Finally, there is weak
evidence of a positive effect of P4Q on the referral rate for poor glycaemia control
(23% effect size) as a care coordination measure 161 (P).
There is weak evidence for a positive effect on heart failure treatment in primary care: a
23.4% increase in ACE inhibitor use 205 (P).