Effectiveness of UK provider financial incentives on quality of care: a systematic review

Rishi Mandavia, Nishchay Mehta, Anne Schilder and Elias Mossialos. Effectiveness of UK provider financial incentives on quality of care: a systematic review. Br J Gen Pract 9 October 2017; bjgp17X693149. DOI: https://doi.org/10.3399/bjgp17X693149

Provider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency.

Aim To review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care.

Design and setting Systematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.

Method MEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as ‘positive’, those that were ‘intermediate’ showed improvement in some measures, and those classified as ‘negative’ showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist.

Results Of the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points.

Conclusion The effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives — if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK.

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Nine in 10 GPs rated good or outstanding following CQC inspection

Care Quality Commission (CQC) report finds that at the end of its first inspection programme of general practices 4% were rated ‘outstanding’, 86% were ‘good’, 8% were ‘requires improvement’ and 2% were ‘inadequate’.

state of cqc

Image source: http://www.cqc.org.uk

The state of care in general practice 2014 to 2017 presents findings from CQCs  programme of inspections of GP practices. This detailed analysis of the quality and safety of general medical practice in England has found that nearly 90% of general practices in England have been rated as ‘good’, making this the highest performing sector CQC regulates.

Full document: The state of care in general practice 2014 to 2017

New quality of life measure for recovering cancer patients

New ‘quality of life metric’, will use questionnaires to measure how well cancer patients are supported after treatment. | NHS England

NHS England are introducing a new approach to drive improvements in after care which includes personalised plans for people with cancer outlining not only their physical needs, but also other support they may need, such as help at home or financial advice.

The latest national survey shows the vast majority of people with cancer are positive about the NHS care they receive, but there is currently no measure to assess how well patients are supported after treatment.

The new ‘quality of life metric’, which is the first of its kind, will use questionnaires to measure how effective this support is and the data will be made available on My NHS – helping patients, the public, clinicians and health service providers see how well their local after cancer care support is doing.

Full story at NHS England

Improving quality of care through partnerships and collaboration

Partnerships for improvement: ingredients for success | The Health Foundation

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The idea of partnerships and collaboration across organisational boundaries is at the heart of NHS reforms in England. This briefing from the Health Foundation looks at what makes successful partnerships between providers at an organisational level, providing a snapshot of some of the key ingredients needed for successful partnerships.

The report looks at a range of current organisational partnerships focusing on five different partnering arrangements. It also includes interviews with national leaders, and draws learning to help inform and guide policymakers and providers.

The report finds that partnering does have potential benefits, but these are not easy or quick to achieve. To have a meaningful impact on the quality of care, the right form of partnering needs to be used in the right context and it needs to be accompanied by the right set of enabling factors – as described by the report.

Full briefing: Partnerships for improvement: ingredients for success

Related: Health Foundation blog: Is together always better? How good are NHS organisations and the wider system at achieving the potential benefits of partnering?

Measuring quality of health care in the NHS: Giving a voice to the patients

The high profile role that the NHS played in Brexit and recent general election campaigns demonstrates that the health care system remains foremost in the minds of all political parties when considering how to present their policies | The Health Foundation

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These campaigns put a spotlight on the sustainability of the health care system, but may have also fuelled a fear over deteriorating health system performance. In 2017, the NHS was recently ranked by the Commonwealth Fund as the best performing health care system out of 11 countries, including Germany, Australia and the United States. However, 82% of the general public expressed concerns about the future of the NHS in a survey following the 2017 General Election, with quality of care identified as one reason for dissatisfaction previously. Arguably, this disparity may be the result of intense media coverage of the human and financial pressures on the NHS, which could have shaped public perception to some extent. However, it might also point to a deeper disparity: a disconnect between the general assessment of measurable health system performance versus the quality of care perceived by patients when accessing the NHS.

One reason for this relates to the difficulty in measuring quality of health care at the system level. Quality in the context of health care is a multi-dimensional framework that captures six domains:

  • Effectiveness
  • Efficiency
  • Equity
  • Safety
  • Timeliness
  • Patient-centeredness.

Read the full blog post by Rocco Friebel here

UK top in primary care co-ordination according to international survey

The UK emerges as the first of 11 countries in an international survey of care co-ordination in primary care settings | The Commonwealth Fund

In a survey of health care experiences in 11 high-income countries, the rate of poor primary care coordination was 5.2 percent overall and 9.8 percent in the United States, the highest rate. Patients who have a positive, established relationship with their provider were less likely to report poor primary care coordination. Being young or having a chronic illness was associated with poor care coordination.

care coordination gaps

Image source: The Commonwealth Fund

The dimensions of care coordination assessed for this study were:

  • access to medical records or test results;
  • receiving conflicting information;
  • use of diagnostic tests that the patient felt were unnecessary; sharing of information between primary care doctor and specialist.

The UK had the highest percentage of patients reporting no care coordination gaps within primary care.

Full results can be accessed here

 

National health organisations publish a shared commitment to quality

The National Quality Board (NQB) has today (21 December) published a new framework that will promote improved quality criteria across all national health organisations for the first time | NHS England

shared-quality

Image source: NHS England

The new publication provides a nationally agreed definition of quality and guide for clinical and managerial leaders wanting to improve quality.

The approach has been agreed by the national bodies that form the NQB to provide more consistency and to enable the system to work together more effectively.

It is part of work to cut unnecessary red tape by reducing duplication and aligning demands on professionals for information on the quality of services.

The document sets out a range of measures to achieve higher and consistent standards including: the need for a common language that people who use services understand; to ensure commissioners and providers experience a coherent system of assurance, measurement and regulation; that professionals and staff are equipped and empowered to deliver safe, effective, and responsive care; and leaders should create a culture where people feel free to speak up when something goes wrong.

Read the full overview here

Read the full framework here