title: Risk of Care Home Placement following Acute Hospital Admission: Effects of a Pay-for-Performance Scheme for Dementia.
abstract: The Quality and Outcomes Framework, or QOF, rewards primary care doctors (GPs) in the UK for providing certain types of care. Since 2006, GPs have been paid to identify patients with dementia and to conduct an annual review of their mental and physical health. During the review, the GP also assesses the carer's support needs, including impact of caring, and ensures that services are co-ordinated across care settings. In principle, this type of care should reduce the risk of admission to long-term residential care directly from an acute hospital ward, a phenomenon considered to be indicative of poor quality care. However, this potential effect has not previously been tested.
  
  
  
  Using English data from 2006/07 to 2010/11, we ran multilevel logit models to assess the impact of the QOF review on the risk of care home placement following emergency admission to acute hospital. Emergency admissions were defined for (a) people with a primary diagnosis of dementia and (b) people with dementia admitted for treatment of an ambulatory care sensitive condition. We adjusted for a wide range of potential confounding factors.
  
  
  
  Over the study period, 19% of individuals admitted to hospital with a primary diagnosis of dementia (N = 31,120) were discharged to a care home; of those admitted for an ambulatory care sensitive condition (N = 139,267), the corresponding figure was 14%. Risk factors for subsequent care home placement included older age, female gender, vascular dementia, incontinence, fall, hip fracture, and number of comorbidities. Better performance on the QOF review was associated with a lower risk of care home placement but only when the admission was for an ambulatory care sensitive condition.
  
  
  
  The QOF dementia review may help to reduce the risk of long-term care home placement following acute hospital admission.
authors.affiliation: Centre for Health Economics, University of York, York, United Kingdom.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Kasteridis
authors.affiliation: Centre for Health Economics, University of York, York, United Kingdom.
authors.forename: Anne
authors.identifier: 0000-0002-5823-3064
authors.initials: A
authors.lastname: Mason
authors.affiliation: Centre for Health Economics, University of York, York, United Kingdom.
authors.forename: Maria
authors.initials: M
authors.lastname: Goddard
authors.affiliation: Centre for Health Economics, University of York, York, United Kingdom.
authors.forename: Rowena
authors.initials: R
authors.lastname: Jacobs
authors.affiliation: Centre for Health Economics, University of York, York, United Kingdom.
authors.forename: Rita
authors.initials: R
authors.lastname: Santos
authors.affiliation: Department of Economics, Econometrics and Finance, SOM Research Institute, University of Groningen, 9700 AV Groningen, The Netherlands.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Rodriguez-Sanchez
authors.affiliation: Department of Medicine for the Elderly, York Teaching Hospital NHS Foundation Trust, York, United Kingdom.
authors.forename: Gerard
authors.initials: G
authors.lastname: McGonigal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010343:Patient Admission; D010351:Patient Discharge; D011787:Quality of Health Care / Q000592:standards*; D012052:Reimbursement, Incentive; D012189:Retrospective Studies; D012307:Risk Factors