Pay for Quality
Pay for Quality
Pay for Quality
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KCE Reports 118 <strong>Pay</strong> <strong>for</strong> <strong>Quality</strong> 57<br />
4.3.1.4 Generic findings<br />
With regard to chronic disease management <strong>for</strong> multiple patient groups strong evidence<br />
is available on a positive relationship with preventive and chronic care targets and on<br />
the absent or positive relationship with not incentivized targets 153 , 200 , 206 (P). Weak<br />
evidence indicates a positive relationship with the quality improvement initiative rate<br />
200<br />
(P).<br />
On the overall QOF achievement there is weak evidence on a 4.2% P4Q effect, with a<br />
marginal increase in drug prescription (0.69-1.09%) 126 , 148 (P). There is also weak<br />
evidence that the percentage of targets achieved was 16.9% higher <strong>for</strong> incentivized<br />
targets as compared to not incentivized targets 162 (P).<br />
With regard to care management processes (CMP) use, there is weak evidence of a<br />
positive effect on IT use (9-27%), and on clinical guideline use 194 , 203 (H&P).<br />
Furthermore the evidence on CMP use is mixed.<br />
Regarding patient and provider satisfaction there is a lack of evidence available. Weak<br />
evidence indicates no relationship with patient satisfaction, providers’ quality of life and<br />
nurses’ perceived demands 218 (P). For physicians, a higher workload was reported. In<br />
addition, both physicians and nurses reported a management structure support. Intrinsic<br />
motivation showed no difference or a positive effect 218 (P). There is weak evidence that<br />
P4Q based on patient satisfaction targets is positively related to perceived access to<br />
care, patient knowledge and use of preventive counselling.<br />
There was no relationship with perceived continuity, integration of care, clinical<br />
interaction, interpersonal treatment and trust 204 (P).<br />
Next to the above reported effect of P4Q programmes, it is also important to take the<br />
variability-reduction or variability-increase into consideration. After all, a positive effect<br />
can be attended with a greater variability which is not desirable. However, few articles<br />
mention the variability.<br />
Concerning preventive care, variability data were found <strong>for</strong> immunisation achievement<br />
and screening rate. For most of these indicators, there is a considerable decrease in<br />
variability after implementing P4Q programmes, only cervical cancer screening shows an<br />
increase in variability. For the immunisation rate there are conflicting results, although in<br />
most cases a variability reduction can be found 69 , 178 , 188 , 214 (H&P).<br />
Concerning the indicators belonging to acute care, no article mentions the variability.<br />
Regarding chronic care, some articles about diabetes, asthma, hypertension en smoking<br />
cessation mention the variability. Most diabetes process indicators showed a huge<br />
decrease in variability. However some process indicators, like retinal screening, lipid<br />
testing, nephropathy testing, retinal testing, ACE inhibitor or all blocker use, and<br />
microalbumine recording showed an increase in variability or conflicting results.<br />
Variability of Intermediate outcome parameters also shows a mixed result. Achieving<br />
the blood pressure and HbA1c target showed a large decrease in variability. Achieving<br />
the cholesterol target shows a large increase in variability. The amount of asthma and<br />
hypertension indicators achieved, showed less variability when introducing P4Q<br />
programmes and all smoking cessation indicators showed no difference in variability of a<br />
decrease in variability after implementation of P4Q programmes.<br />
However these decreases were rather small. Concerning generic findings, some QOF<br />
indicators and several patient and providers satisfaction indicators showed a decrease in<br />
variability, however the degree of decrease <strong>for</strong> the latter was very small.