Pay-for-performance in the United Kingdom: impact of the quality and outcomes framework: a systematic review.
Ann Fam Med
; 10(5): 461-8, 2012.
Article
en En
| MEDLINE
| ID: mdl-22966110
ABSTRACT
PURPOSE:
Primary care practices in the United Kingdom have received substantial financial rewards for achieving standards set out in the Quality and Outcomes Framework since April 2004. This article reviews the growing evidence for the impact of the framework on the quality of primary medical care.METHODS:
Five hundred seventy-five articles were identified by searching the MEDLINE, EMBASE, and PsycINFO databases, and from the reference lists of published reviews and articles. One hundred twenty-four relevant articles were assessed using a modified Downs and Black rating scale for 110 observational studies and a Critical Appraisal Skills Programme rating scale for 14 qualitative studies. Ninety-four studies were included in the review.RESULTS:
Quality of care for incentivized conditions during the first year of the framework improved at a faster rate than the preintervention trend and subsequently returned to prior rates of improvement. There were modest cost-effective reductions in mortality and hospital admissions in some domains. Differences in performance narrowed in deprived areas compared with nondeprived areas. Achievement for conditions outside the framework was lower initially and has worsened in relative terms since inception. Some doctors reported improved data recording and teamwork, and nurses enhanced specialist skills. Both groups believed that the person-centeredness of consultations and continuity were negatively affected. Patients' satisfaction with continuity declined, with little change in other domains of patient experience.CONCLUSIONS:
Observed improvements in quality of care for chronic diseases in the framework were modest, and the impact on costs, professional behavior, and patient experience remains uncertain. Further research is needed into how to improve quality across different domains, while minimizing costs and any unintended adverse effects of payment for performance schemes. Health care organizations should remain cautious about the benefits of similar schemes.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Atención Primaria de Salud
/
Calidad de la Atención de Salud
/
Reembolso de Incentivo
Tipo de estudio:
Guideline
/
Observational_studies
/
Qualitative_research
/
Systematic_reviews
Límite:
Humans
País/Región como asunto:
Europa
Idioma:
En
Revista:
Ann Fam Med
Asunto de la revista:
MEDICINA DE FAMILIA E COMUNIDADE
Año:
2012
Tipo del documento:
Article
País de afiliación:
Reino Unido