UK’s Quality And Outcomes Framework A National Primary Care Pay-For-Performance Scheme Delivers Modest Improvements In Quality
A systematic review of the growing body of evidence regarding the United Kingdom’s Quality and Outcomes Framework, arguably the most comprehensive national primary care pay-for-performance scheme in the world, finds modest improvements in quality of care since its introduction in 2004.
The review, which included 94 studies, found the QOF was associated with an increased rate of improvement of quality of care for incentivized conditions during the first year of implementation, returning to preintervention rates of improvement in subsequent years. It also found modest cost-effective reductions in mortality and hospital admissions in some domains.
The analysis showed the QOF has led to narrowing of differences in performance in deprived areas compared with nondeprived areas. Some doctors reported improved data recording and teamwork, and nurses reported enhanced specialist skills. Both groups, however, believed the patient-centeredness of consultations and continuity were negatively affected by QOF.
Remarkably little is known of what patients make of the changes, although anecdotal reports point to unintended consequences detracting from patient-centered care.
In view of the findings, the authors recommend policy makers continue to exercise caution about implementing similar schemes, and they call for future research into how to improve quality across different domains while minimizing costs and any unintended adverse effects.
“Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework – A Systematic Review”
By Stephen J. Gillam, MD, FFPH, FRCP, FRCGP, et al
University of Cambridge, England
September/October 2012 Annals of Family Medicine