Article Figures & Data
Figures
- 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.
Tables
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
Supplemental Tables
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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