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Review ArticleSystematic Review

Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework—A Systematic Review

Stephen J. Gillam, A. Niroshan Siriwardena and Nicholas Steel
The Annals of Family Medicine September 2012, 10 (5) 461-468; DOI: https://doi.org/10.1370/afm.1377
Stephen J. Gillam
1Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, England
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  • For correspondence: sjg67@medschl.cam.ac.uk
A. Niroshan Siriwardena
2Faculty of Health, Life & Social Sciences, University of Lincoln, England
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Nicholas Steel
3Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, England
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    Figure 1

    Flow of information through the review.

    a Of the 575 articles, 348 were from MEDLINE, 294 were from EMBASE, and 55 were from PsycINFO, including duplicates.

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    Table 1

    Domains of the Quality and Outcomes Framework

    Clinical
    Secondary prevention of coronary heart disease
    Cardiovascular disease: primary prevention
    Heart failure
    Stroke and transient ischemic attack
    Hypertension
    Diabetes mellitus
    Chronic obstructive pulmonary disease
    Epilepsy
    Hypothyroidism
    Cancer
    Palliative care
    Mental health
    Asthma
    Dementia
    Depression
    Chronic kidney disease
    Atrial fibrillation
    Obesity
    Learning disabilities
    Smoking
    Organizational
    Records and information
    Information for patients
    Education and training
    Practice management
    Medicines management
    Patient Experience
    Length of consultations
    Patient survey (access)
    Additional Services
    Cervical screening
    Child health surveillance
    Maternity services
    Contraception

Additional Files

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    Supplemental Table 1. Impact of Quality and Outcomes Framework (QOF) on Effective Care: Description of Studies Reviewed; Supplemental Table 2. Impact of Quality of Outcomes Framework (QOF) on Efficiency and Costs: Description of Studies Reviewed; Supplemental Table 3. Impact of Quality of Outcomes Framework (QOF) on Equity: Description of Studies Reviewed; Supplemental Table 4. Impact of Quality of Outcomes Framework (QOF) on Patient Experience: Description of Studies Reviewed; Supplemental Table 5. Impact of Quality of Outcomes Framework (QOF) on Professionals and Team Working: Description of Studies Reviewed.

    Files in this Data Supplement:

    • Supplemental data: Table 1 - PDF file, 10 pages, 352 KB
    • Supplemental data: Table 2 - PDF file, 2 pages, 184 KB
    • Supplemental data: Table 3 - PDF file, 3 pages, 270 KB
    • Supplemental data: Table 4 - PDF file, 2 pages, 201 KB
    • Supplemental data: Table 5 - PDF file, 2 pages, 197 KB
  • The Article in Brief

    Stephen J. Gillam , and colleagues

    Background The UK Quality and Outcomes Framework (QOF) is arguably the most comprehensive national primary care pay-for-performance program in the world. It is a complex program of financial incentives and information technology to promote structured and team-based care with the aim of improving quality of care. This study analyzes existing research to determine the impact of the QOF on the quality of primary medical care in the United Kingdom.

    What This Study Found There have been modest improvements in quality of care since the QOF was introduced in 2004. The QOF improved quality of care for incentivized conditions during its first year of implementation, and returned to preintervention rates of improvement in the following years. There have been some modest cost-effective reductions in mortality and hospital admissions, and narrowing of differences in performance in deprived areas compared with nondeprived areas. Some doctors report improved data recording and teamwork, and nurses report enhanced specialist skills. Both groups, however, believe that patient-centeredness of consultations and continuity are negatively affected by QOF. Little is known of what patients think of the changes, although anecdotal reports suggest that unintended consequences may be detracting from patient-centered care.

    Implications

    • In view of the findings, the authors recommend policy makers continue to be cautious about implementing similar programs, and they call for future research into how to improve quality across different domains while minimizing costs and unintended adverse effects.
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The Annals of Family Medicine: 10 (5)
The Annals of Family Medicine: 10 (5)
Vol. 10, Issue 5
September/October 2012
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Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework—A Systematic Review
Stephen J. Gillam, A. Niroshan Siriwardena, Nicholas Steel
The Annals of Family Medicine Sep 2012, 10 (5) 461-468; DOI: 10.1370/afm.1377

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Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework—A Systematic Review
Stephen J. Gillam, A. Niroshan Siriwardena, Nicholas Steel
The Annals of Family Medicine Sep 2012, 10 (5) 461-468; DOI: 10.1370/afm.1377
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  • Large Performance Incentives Had The Greatest Impact On Providers Whose Quality Metrics Were Lowest At Baseline
  • Does paying for performance in primary care save lives?
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  • Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study
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  • Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study
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  • Increased Risk of Subsequent Myocardial Infarction in Patients With Type 2 Diabetes: A Retrospective Cohort Study Using the U.K. General Practice Research Database
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  • Increasing the QOF upper payment threshold in general practices in England: impact of implementing government proposals
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