Quality of clinical primary care and targeted incentive payments: an observational study.
BACKGROUND
Payments for recorded evidence of quality of clinical care in UK general practices were introduced in 2004.


OBJECTIVE
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.


METHODS
Retrospective observational study comparing incentivised and non-incentivised indicators of quality of care.


METHODS
Eighteen general practices in England.


METHODS
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).


CONCLUSIONS
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.
Steel
Nicholas
N
Primary Care Group, School of Medicine, University of East Anglia, Norwich. n.steel@uea.ac.uk
Maisey
Susan
S
Clark
Allan
A
Fleetcroft
Robert
R
Howe
Amanda
A
D004739:England; D005194:Family Practice / Q000191:economics / Q000592:standards*; D006801:Humans; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive; D012189:Retrospective Studies