Participatory pay-for-performance improves primary care

By Liam Davenport, medwireNews Reporter

Both quality of care measures and patient experience may be achieved through the introduction of a participatory pay-for-performance (P4P) program, study findings indicate.

"Clinical care indicators, pertaining to both process and outcome, concerning diabetes, chronic obstructive pulmonary disease [COPD], asthma and cardiovascular [CV] risk management improved, though only the process indicators were incentivized," report Kirsten Kirschner from Radboud University Nijmegen Medical Centre, the Netherlands, and team.

Noting some of the documented concerns associated with the implementation of the UK Quality and Outcomes Framework, they add in Family Practice: "Having the target users involved makes it possible to deal with these problems, for instance by renewing the set periodically, which might enlarge the potential effect of P4P."

The team assessed 60 general practices that took part in designing and implementing a P4P program that incorporated clinical care indicators for diabetes, COPD, asthma, CV risk management, influenza vaccination, and cervical cancer screening, alongside practice management and patient experience indicators, with a maximum bonus of € 6890 (US$ 8886) per 1000 patients.

There were significant improvements on all clinical process indicators for diabetes, four of five COPD indicators, three of four asthma indicators, and three of eight CV risk management indicators, with improvements ranging from 4.2% to 26.3%. There were no improvements on influenza vaccination and cervical cancer screening indicators.

The degree of improvement was affected by baseline performance, practice type, and urbanization levels. For example, group practices with an average baseline score showed a mean decline of 0.9%, and every percentage point a practice scored higher than the average baseline was associated with a further decline of 0.4%.

The results also showed that solo practices improved 15.4% more than group practices, while duo practices improved 14.0% more than group practices, with relative improvements even greater on asthma indicators.

Significant improvements were seen on five of seven incentivized clinical outcome indicators, ranging from 5.9% to 14.7%. In large cities, practices improved 14.4% less than those in rural areas on the diabetes indicator for glycated hemoglobin.

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