Pay for Quality

KCE Reports 118 Pay for Quality 83
5.1.9 Patient characteristics
The evidence on relationships of patient demographics has been described extensively
in the previous section. With regard to age, ethnicity and socio-economical deprivation
level positive as well as negative results were found, depending on the disease (W). This
will be discussed more extensively in section 5.2.3.
Currently there is a lack of research and evidence on the effects of patient educational
status and insurance status.
There are also no negative findings reported with regard to the use of exception
reporting as a P4Q supportive tool in the UK (W).
Almost no empirical research has focused upon the patient experience and patient
satisfaction with regard to P4Q. The Spanish study as one exception found no significant
differences (W). There is no further evidence on how P4Q and patient awareness of
P4Q affects the patient provider relationship.
Finally, patient behaviour in terms of lifestyle, cooperation and therapeutic compliance
might affect P4Q results, as described by the conceptual framework. Again, there is a
lack of evidence on this specific topic. However, as part of P4Q target setting and
measurement the selection of indicators in the included studies indicates that this issue
is taken into account in almost all studies. The structure, process and intermediate
outcome measures used have a high degree of provider controllability. There are a few
exceptions like the use of long term smoking cessation outcomes, which is in general
less controllable and more patient lifestyle related.
Figure 9: P4Q context: Patient characteristics
Patient characteristics
Demographics, Co-morbidities:
Closing performance gap with regard to patient age and unclear result with regard to gender, and ethnicity
(W)
Socio-economics, Insurance status:
Unclear results with regard to socio economical deprivation level (W)
Lack of reporting on the influence of insurance status (N)
Information about price and/or quality:
Conflicting evidence on the interaction of P4Q with public reporting (C)
Patient behavioural patterns (cultural and consumer patterns, compliance):
Lack of reporting (N)
5.2 DISCUSSION AND CONCLUSIONS
5.2.1 Reported effect of Pay for Quality programmes
Previous systematic reviews found that the evidence on P4Q effectiveness is mixed,
with initial studies finding a lack of impact or incongruent effects which are target
specific. They also reported a lack of evidence on the incidence of unintended
consequences of P4Q. A high need for further research on these issues was expressed
15 , 16 , 37 , 38 , 40, 46 , 75 , 92 , 231 , 232 , 233 , 234 . The systematic review that was performed in this
chapter builds further on a wider search strategy to identify more primary P4Q
evaluation studies. In addition, it provides an update of the findings till 2009 as year of
publication. Because a lot of studies have been published in 2007 and 2008, this review
allowed assessing whether already more evidence is available on P4Q development,
implementation and evaluation, how this relates to our conceptual framework and
which recommendations can be formulated for research and practice, both within an
international and a Belgian scope.