Abstract
National financial incentive schemes for improving the quality of primary care have come under criticism in the United Kingdom, leading to calls for localized alternatives. This study investigated whether a local general practice incentive-based quality improvement scheme launched in 2011 in a city in the North West of England was associated with a reduction in all-cause emergency hospital admissions. Difference-in-differences analysis was used to compare the change in emergency admission rates in the intervention city, to the change in a matched comparison population. Emergency admissions rates fell by 19 per 1,000 people in the years following the intervention (95% confidence interval [17, 21]) in the intervention city, relative to the comparison population. This effect was greater among more disadvantaged populations, narrowing socioeconomic inequalities in emergency admissions. The findings suggest that similar approaches could be an effective component of strategies to reduce unplanned hospital admissions elsewhere.
Highlights
The United Kingdom has been at the forefront of developing incentive schemes to improve the quality and efficiency of general practice
The Quality and Outcomes Framework (QOF) was introduced nationally in the United Kingdom in 2004, allocating 25% of general practitioners (GP) income based on the achievement of quality targets for the management of chronic and severe conditions, as well as indicators related to practice organization and patient experience (Guthrie et al, 2006; Roland & Guthrie, 2016; see https://qof.digital.nhs.uk/ for a description of the national indicators)
There have been a considerable number of studies and systematic reviews investigating the effects of incentive schemes on quality, cost, efficiency, and equity of primary care provision
Summary
The United Kingdom has been at the forefront of developing incentive schemes to improve the quality and efficiency of general practice. Studies investigating the health inequalities impact of such schemes have been mixed (Alshamsan et al, 2010), with some studies indicating that they increase inequalities (Alshamsan et al, 2010; Roland & Dudley, 2015), whilst Doran et al (2008) showed that QOF was successful in reducing the inequalities indicators for the first 3 years of deployment, though it was not persistent in its positive effects (Dixon & Khachatryan, 2010) Due to this mounting criticism, there have been suggestions to amend the QOF (Doran et al, 2017; Minchin et al, 2018; Pandya et al, 2018), including handing control over to local primary care systems (Hackett et al, 2014; Glidewell et al, 2015). Quality improvement incentive schemes, including these components may be effective in other settings
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