Impact of 'stretch' targets for cardiovascular disease management within a local pay-for-performance programme.

Pay-for-performance programs are often aimed to improve the management of chronic diseases. We evaluate the impact of a local pay for performance programme (QOF+), which rewarded financially more ambitious quality targets ('stretch targets') than those used nationally in the Quality and Ou...

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Main Authors: Utz J Pape, Kit Huckvale, Josip Car, Azeem Majeed, Christopher Millett
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2015-01-01
Series:PLoS ONE
Online Access:http://europepmc.org/articles/PMC4374919?pdf=render
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spelling doaj-9a26893d82ba4aebb87578192c4e14542020-11-25T02:32:11ZengPublic Library of Science (PLoS)PLoS ONE1932-62032015-01-01103e011918510.1371/journal.pone.0119185Impact of 'stretch' targets for cardiovascular disease management within a local pay-for-performance programme.Utz J PapeKit HuckvaleJosip CarAzeem MajeedChristopher MillettPay-for-performance programs are often aimed to improve the management of chronic diseases. We evaluate the impact of a local pay for performance programme (QOF+), which rewarded financially more ambitious quality targets ('stretch targets') than those used nationally in the Quality and Outcomes Framework (QOF). We focus on targets for intermediate outcomes in patients with cardiovascular disease and diabetes. A difference-in-difference approach is used to compare practice level achievements before and after the introduction of the local pay for performance program. In addition, we analysed patient-level data on exception reporting and intermediate outcomes utilizing an interrupted time series analysis. The local pay for performance program led to significantly higher target achievements (hypertension: p-value <0.001, coronary heart disease: p-values <0.001, diabetes: p-values <0.061, stroke: p-values <0.003). However, the increase was driven by higher rates of exception reporting (hypertension: p-value <0.001, coronary heart disease: p-values <0.03, diabetes: p-values <0.05) in patients with all conditions except for stroke. Exception reporting allows practitioners to exclude patients from target calculations if certain criteria are met, e.g. informed dissent of the patient for treatment. There were no statistically significant improvements in mean blood pressure, cholesterol or HbA1c levels. Thus, achievement of higher payment thresholds in the local pay for performance scheme was mainly attributed to increased exception reporting by practices with no discernable improvements in overall clinical quality. Hence, active monitoring of exception reporting should be considered when setting more ambitious quality targets. More generally, the study suggests a trade-off between additional incentive for better care and monitoring costs.http://europepmc.org/articles/PMC4374919?pdf=render
collection DOAJ
language English
format Article
sources DOAJ
author Utz J Pape
Kit Huckvale
Josip Car
Azeem Majeed
Christopher Millett
spellingShingle Utz J Pape
Kit Huckvale
Josip Car
Azeem Majeed
Christopher Millett
Impact of 'stretch' targets for cardiovascular disease management within a local pay-for-performance programme.
PLoS ONE
author_facet Utz J Pape
Kit Huckvale
Josip Car
Azeem Majeed
Christopher Millett
author_sort Utz J Pape
title Impact of 'stretch' targets for cardiovascular disease management within a local pay-for-performance programme.
title_short Impact of 'stretch' targets for cardiovascular disease management within a local pay-for-performance programme.
title_full Impact of 'stretch' targets for cardiovascular disease management within a local pay-for-performance programme.
title_fullStr Impact of 'stretch' targets for cardiovascular disease management within a local pay-for-performance programme.
title_full_unstemmed Impact of 'stretch' targets for cardiovascular disease management within a local pay-for-performance programme.
title_sort impact of 'stretch' targets for cardiovascular disease management within a local pay-for-performance programme.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2015-01-01
description Pay-for-performance programs are often aimed to improve the management of chronic diseases. We evaluate the impact of a local pay for performance programme (QOF+), which rewarded financially more ambitious quality targets ('stretch targets') than those used nationally in the Quality and Outcomes Framework (QOF). We focus on targets for intermediate outcomes in patients with cardiovascular disease and diabetes. A difference-in-difference approach is used to compare practice level achievements before and after the introduction of the local pay for performance program. In addition, we analysed patient-level data on exception reporting and intermediate outcomes utilizing an interrupted time series analysis. The local pay for performance program led to significantly higher target achievements (hypertension: p-value <0.001, coronary heart disease: p-values <0.001, diabetes: p-values <0.061, stroke: p-values <0.003). However, the increase was driven by higher rates of exception reporting (hypertension: p-value <0.001, coronary heart disease: p-values <0.03, diabetes: p-values <0.05) in patients with all conditions except for stroke. Exception reporting allows practitioners to exclude patients from target calculations if certain criteria are met, e.g. informed dissent of the patient for treatment. There were no statistically significant improvements in mean blood pressure, cholesterol or HbA1c levels. Thus, achievement of higher payment thresholds in the local pay for performance scheme was mainly attributed to increased exception reporting by practices with no discernable improvements in overall clinical quality. Hence, active monitoring of exception reporting should be considered when setting more ambitious quality targets. More generally, the study suggests a trade-off between additional incentive for better care and monitoring costs.
url http://europepmc.org/articles/PMC4374919?pdf=render
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