Pay for Quality

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