Pay for Quality

More documents

Recommendations

Info

66 Pay for Quality KCE Reports 118 4.5 EVIDENCE RELATED TO EQUITY The initial aim of this paragraph was to assess the impact of P4Q initiatives on equity in access, treatment and outcomes. An important first step was to assess how equity is conceptualized in the selected studies (to what extent did the selected papers address the three domains of equity and did they conceptualize equity as vertical or horizontal or both?). Since the selected publications do not include information on access, the following paragraph will mainly focus on equity in treatment and treatment outcomes. Out of the 32 selected publications, 27 address the relatively new Pay for Quality initiative in the UK. Sixteen of them use the QOF database to do this. The other ten studies make use of alternative databases. This relatively large number of studies on the UK initiative should make it possible to get a broad and deep insight on its impact on equity. Since the 5 other publications each cover another P4Q initiative, we do not get enough in-depth insight in these initiatives to make conclusions on their impact on equity. Therefore the focus of this paragraph will be on QOF. Inequity in health care occurs when systematically differences are found in access, treatment or outcomes for people from certain subgroups in society. The assessment of equity for socioeconomic groups receives by far-out most attention in the selected studies (in 22 of the 26 selected studies on pay-for-performance in the UK). Socioeconomic status is hereby defined using the area-level Index of Multiple Deprivation or the DEPCAT score (supra). A smaller number of studies (11) also address equity in health care for patients with a different ethnic background. Finally, a few studies also look at gender differences (6 studies) or differences in age groups (7 studies). 4.5.1 Reported evidence on equity In this part of the chapter we summarize the available evidence on the effect of the introduction of the QOF in the UK on equity in treatment and (intermediate) treatment outcomes. We first summarize the available evidence on the total QOF score, followed by the available evidence per condition (cardiovascular diseases and diabetes), the evidence on the measuring of blood pressure independent from a specific condition and finally the evidence on exception reporting. According to the labels used on page 54, all equity related publications were graded as “weak evidence”. 4.5.1.1 Total QOF-score Two cross-sectional studies 142 , 148 provide information on the evolution of the total QOF score after the introduction of the QOF. In their analyses Doran et al (2008) adjusted for area characteristics (deprivation, population density), patient characteristics (% >or= 15 years of age, >or= 65 years of age, % of women, % of ethnic minority), practice characteristics (size of practice population, number of GPs per 10 000 patients, primary medical services contract), GP characteristics (age, gender, % medically educated in the UK) and exclusion rate. 148 Ashworth et al. (2007) analyzed the raw QOF data and where possible adjusted for exception reporting. 142 Both studies showed that the existing (but small) gap in overall quality of care between deprived areas (the more deprived, the lower the overall quality) after the introduction 142 , 148 of the QOF, narrowed during the years following the introduction of the QOF. According to Doran et al. (2008) the gap in median achievement between year 1 after the introduction of QOF and year 3 narrowed from 4.0% to 0.8%. Practices in areas with initial low quality achievement (i.e. the more deprived areas) report the greatest increases during the following years. This more rapid improvement in achievement of overall quality in practices located in more deprived area quintiles was therefore attributable to poorer initial performance and not to being located in a deprived area per se. 148
KCE Reports 118 Pay for Quality 67 4.5.1.2 Per condition Coronary heart disease Two historical before-after studies assessed quality of care as defined by QOF for coronary heart disease (CHD). Mc Govern (2008) selected 11 CDH related indicators and compared the achievement rates at pre- and post contract time points, adjusting for age, sex, number of comorbidities, deprivation and practice size. He found a dramatic rise in the recording of CHD related quality indicators. Post-contract, disparities between patient subgroups, continued for some components of care. Women were less likely to be recorded than men in 9 of the 11 components of care, older patients (75+) in 7 of the 11 components of care and the most deprived in 4 of the 11 components of care. A secondary analysis of one of the included tables in the paper identifies an increase of the inequity gap for women (inequity for 7 indicators pre-contract, inequity for 9 indicators post-contract) and for deprived patients (inequity for 1 indicator pre-contract, inequity for 4 indicators post-contract) and a reduction in the inequity gap for older patients (inequity for 9 indicators pre-contract, inequity for 7 indicators post-contract). The authors did not describe this in the findings. 127 Millet et al (2008) selected 10 CHD related QOF indicators and compared the achievement rates at pre- and post-contract time points (2003 versus 2005) according to the ethnicity of the patients and adjusting for age, gender, deprivation and practice clustering. Pre-contract Blacks scored significantly worse than whites on 2 of the 10 indicators (BP control and statins prescribed). Post-contract the blood pressure control and the statin prescribing increased for both Whites and Blacks but the improvements were greater in the Blacks compared to the Whites, attenuating the disparities evident pre-contract (no significant difference any more post-contract). Pre-contract South Asians scored significantly worse than Whites for the measurement of BP but this gap disappeared post-contract thanks to a larger increase in the achievement scores in South Asians than in Whites. Additionally, the increase in achievement scores for the measurement of BMI, the measurement of cholesterol and control of BP was greater for South Asians than for Whites resulting in significant better results for South Asians. 157 Cerebrovascular disease (stroke/TIA) Simpson et al (2006) found that the recording of stroke related QOF indicators increased after the introduction of the contract. Larger increases in the recording of risk factors in the oldest patients attenuated the pre-contract age differences. Women had larger increases in recording of quality indicators over time than men, however promen gender differences persisted in some components of care. More affluent patients tended to have larger increases in recording of quality indicators than did the most deprived. This resulted in increasing deprivation differences over time in certain aspects: the recording of a magnetic resonance imaging/computed tomography scan, smoking, cholesterol, antiplatelet or anticoagulant therapy, and influenza vaccination. A significant difference between the most and least deprived patients emerged after the contract, with the most deprived stroke patients being less likely to have a record of smoking status and blood pressure. In this study Simpson et al. adjusted for sex, age, number of stroke related co morbidities, deprivation and practice. 135 Diabetes Mc Govern et al (2008) selected 8 diabetes related QOF indicators (especially intermediate outcome parameters) before and after introduction of the new GMS contract in 2004. They adjusted for sex, age, number of co morbidities and deprivation. After the introduction of QOF a general rise in recording of quality indicators was observed. Few statistically significant differences were found between deprivation groups (only for recording BP). Differences between the oldest and youngest age groups (+75 versus -65) in the pre-contract dataset disappeared in the post-contract dataset.
Page 1 and 2:
Voordelen, nadelen en haalbaarheid
Page 3 and 4:
Voordelen, nadelen en haalbaarheid
Page 5 and 6:
Externe validatoren : Simpson (Univ
Page 7 and 8:
KCE Reports 118A Pay for Quality ii
Page 9 and 10:
KCE Reports 118A Pay for Quality iv
Page 11 and 12:
KCE Reports 118A Pay for Quality vi
Page 13 and 14:
KCE Reports 118A Pay for Quality vi
Page 15 and 16:
KCE Reports 118 Pay for Quality 1 S
Page 17 and 18:
KCE Reports 118 Pay for Quality 3 9
Page 19 and 20:
KCE Reports 118 Pay for Quality 5 W
Page 21 and 22:
KCE Reports 118 Pay for Quality 7 S
Page 23 and 24:
KCE Reports 118 Pay for Quality 9 2
Page 25 and 26:
KCE Reports 118 Pay for Quality 11
Page 27 and 28:
Page 29 and 30: KCE Reports 118 Pay for Quality 15
Page 77 and 78: Clinical domain (disease) KCE Repor
Page 79: KCE Reports 118 Pay for Quality 65
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191:
Page 194 and 195:
Wettelijk depot : D/2008/10.273/50
Page 196 and 197:
37. HTA Magnetische Resonantie Beel
Page 198:
108. Tiotropium in de behandeling v
show all

Pay for Quality

Create successful ePaper yourself

Delete template?

Save as template?