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Observational Study
. 2014 Nov 11:349:g6423.
doi: 10.1136/bmj.g6423.

Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study

Mark J Harrison  1 , Mark Dusheiko  2 , Matt Sutton  3 , Hugh Gravelle  4 , Tim Doran  4 , Martin Roland  5
Affiliations
Observational Study

Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study

Mark J Harrison et al. BMJ. .

Abstract

Objective: To estimate the impact of a national primary care pay for performance scheme, the Quality and Outcomes Framework in England, on emergency hospital admissions for ambulatory care sensitive conditions (ACSCs).

Design: Controlled longitudinal study.

Setting: English National Health Service between 1998/99 and 2010/11.

Participants: Populations registered with each of 6975 family practices in England.

Main outcome measures: Year specific differences between trend adjusted emergency hospital admission rates for incentivised ACSCs before and after the introduction of the Quality and Outcomes Framework scheme and two comparators: non-incentivised ACSCs and non-ACSCs.

Results: Incentivised ACSC admissions showed a relative reduction of 2.7% (95% confidence interval 1.6% to 3.8%) in the first year of the Quality and Outcomes Framework compared with ACSCs that were not incentivised. This increased to a relative reduction of 8.0% (6.9% to 9.1%) in 2010/11. Compared with conditions that are not regarded as being influenced by the quality of ambulatory care (non-ACSCs), incentivised ACSCs also showed a relative reduction in rates of emergency admissions of 2.8% (2.0% to 3.6%) in the first year increasing to 10.9% (10.1% to 11.7%) by 2010/11.

Conclusions: The introduction of a major national pay for performance scheme for primary care in England was associated with a decrease in emergency admissions for incentivised conditions compared with conditions that were not incentivised. Contemporaneous health service changes seem unlikely to have caused the sharp change in the trajectory of incentivised ACSC admissions immediately after the introduction of the Quality and Outcomes Framework. The decrease seems larger than would be expected from the changes in the process measures that were incentivised, suggesting that the pay for performance scheme may have had impacts on quality of care beyond the directly incentivised activities.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; MR served as an academic advisor to the government and British Medical Association, negotiating teams during the development of the UK pay for performance scheme during 2001 and 2002.

Figures

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Fig 1 Percentage change in emergency admissions relative to 1998/99 with no adjustment for trend. ACSC=ambulatory care sensitive conditions; QOF=Quality and Outcomes Framework
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Fig 2 Percentage differences between trend adjusted emergency admission rates for incentivised ACSCs (ambulatory care sensitive conditions) and non-incentivised ACSCs and non-ACSCs. The trend adjusted admission rate is the logarithm of the actual admission rate for the year minus the logarithm of the admission rate predicted from fitting a linear trend for the pre-Quality and Outcomes Framework (QOF) period 1998/99-2002/03
See this image and copyright information in PMC

Comment in

  • Quality in primary care.
    Guthrie B, Dreischulte T. Guthrie B, et al. BMJ. 2014 Nov 11;349:g6485. doi: 10.1136/bmj.g6485. BMJ. 2014. PMID: 25389154 No abstract available.

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