Pay for Quality

56 Pay for Quality KCE Reports 118
With regard to coronary heart disease there is strong evidence of an absent effect on
angina attack recording, exercise capacity recording, weight advice, blood pressure
outcome and cholesterol outcome 143 (P). In addition, the following targets showed
below 5% improvements: exercise stress testing referral, dietary advice, aspirin
prescription 143 (P). For three targets the range of effect size was larger, however with
weaker design studies reporting the maximal effects: blood pressure recording (0.7-
21.5%), cholesterol recording (-10.8-41.7%), and smoking status recording (2.39-26.2%)
127, 143
(P). For smoking advice, antiplatelet therapy, ACE inhibitor use and influenza
vaccination there is only weak evidence available for positive effects 127 (P). The
evidence on the effects on the QOF’s additional service domain is mixed 149 (P).
For stroke care only weak evidence is available. The reported effects are large for eight
targets, ranging from 17 to 52.1%, and absent for two targets (blood pressure outcome,
cholesterol outcome) 134 (P).
With regard to asthma care there is limited evidence available. On some targets there is
strong evidence of the absence of an effect (asthma controller use, recording of peak
expiratory flow) 191 (H&P). On others the effect remains below 5% (smoker status
recording, inhaler technique recording, recording of daily, nocturnal or activity-limited
symptoms) 143 (P). There is weak evidence of a positive relationship with care
management processes use and strong evidence of no relationship with not incentivized
measures 143, 186 (P).
On hypertension care there is only weak evidence that P4Q led to an increase of 12%
of targets achieved 163 (P).
There is strong evidence that P4Q has no effect on smoking abstinence and on the
smoking cessation advice rate, although a weaker design study found a 21% positive
effect on the latter target 197 , 201 , 216 (P). However, there is a positive effect on smoker
status recording (7.9-24%) and on the referral rate (6.2%) 196 , 197 , 201 (P).
There is a lack of evidence on the P4Q influence on depression/mental illness primary
care. One weak design study found no effect on the percentage of indicators achieved
163
(P).
Concerning chronic child care there is only weak evidence available of a positive
relationship with receiving outpatient specialty care 173 (P).
There is a lack of evidence on chronic obstructive pulmonary disease (COPD) care.
Weak conflicting evidence is found concerning the relationship between emergency
admission rate and performance on not incentivized measures 149 (P).
With regard to epilepsy there is weak evidence of a small positive relationship between
the seizure free rate and the proportion of emergency hospitalisations, which is not
further explained 159 (P). The impact of P4Q is however unclear.
With regard to chronic kidney disease one weak design study showed a positive effect
on the number of visits, Kt/V rate, ultra filtration volume, albumin rate, haemoglobin
rate, phosphorus rate, calcium rate, catheter use, and the number of skipped
treatments. No effect was found on Kt/V threshold achievement, shortening of
treatments and hospital admission rate 179 (H).
There is a lack of evidence on osteoarthritis care. One weak design study found an
absence of effect on the percentage of targets achieved 162 (P).