BACKGROUND: Payments for recorded evidence of quality of clinical care in UK general practices were introduced in 2004. AIM: To examine the relationship between changes in recorded quality of care for four common chronic conditions from, 2003 to 2005, and the payment of incentives. DESIGN OF STUDY: Retrospective observational study comparing incentivised and non-incentivised indicators of quality of care. SETTING: Eighteen general practices in England. METHOD: Medical records were examined for 1156 patients. The percentage of eligible quality indicators achieved for each patient was assessed in 2003 and 2005. Twenty-one quality indicators referred to asthma and hypertension: six subject to and 15 not subject to incentive payments. Another 15 indicators referred to depression and osteoarthritis which were not subject to incentive payments. RESULTS: A significant increase occurred for the six indicators linked to incentive payments: from 75% achieved in 2003 to 91% in 2005 (change = 16%, 95% confidence interval [CI] = 10 to 22%, P <0.01). A significant increase also occurred for 15 other indicators linked to 'incentivised conditions'; 53 to 64% (change = 11%, 95% CI = 6 to 15%, P <0.01). The 'non-incentivised conditions' started at a lower achievement level, and did not increase significantly: 35 to 36% (change = 2%, 95% CI = -1 to 4%, P = 0.19). CONCLUSION: The introduction of financial incentives was associated with substantial apparent quality improvement for incentivised conditions. For non-incentivised conditions, quality did not appear to improve. Patients with non-incentivised conditions may be at risk of poorer quality care.
BACKGROUND: Payments for recorded evidence of quality of clinical care in UK general practices were introduced in 2004. AIM: To examine the relationship between changes in recorded quality of care for four common chronic conditions from, 2003 to 2005, and the payment of incentives. DESIGN OF STUDY: Retrospective observational study comparing incentivised and non-incentivised indicators of quality of care. SETTING: Eighteen general practices in England. METHOD: Medical records were examined for 1156 patients. The percentage of eligible quality indicators achieved for each patient was assessed in 2003 and 2005. Twenty-one quality indicators referred to asthma and hypertension: six subject to and 15 not subject to incentive payments. Another 15 indicators referred to depression and osteoarthritis which were not subject to incentive payments. RESULTS: A significant increase occurred for the six indicators linked to incentive payments: from 75% achieved in 2003 to 91% in 2005 (change = 16%, 95% confidence interval [CI] = 10 to 22%, P <0.01). A significant increase also occurred for 15 other indicators linked to 'incentivised conditions'; 53 to 64% (change = 11%, 95% CI = 6 to 15%, P <0.01). The 'non-incentivised conditions' started at a lower achievement level, and did not increase significantly: 35 to 36% (change = 2%, 95% CI = -1 to 4%, P = 0.19). CONCLUSION: The introduction of financial incentives was associated with substantial apparent quality improvement for incentivised conditions. For non-incentivised conditions, quality did not appear to improve. Patients with non-incentivised conditions may be at risk of poorer quality care.
Authors: Tim Doran; Catherine Fullwood; Hugh Gravelle; David Reeves; Evangelos Kontopantelis; Urara Hiroeh; Martin Roland Journal: N Engl J Med Date: 2006-07-27 Impact factor: 91.245