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Pay for performance schemes in primary care: what have we learnt?
Stephen Peckham1, Andrew Wallace
1Reader in Health Policy, Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK.
Quality in Primary Care
|June 10, 2010
Summary
Pay for performance (P4P) schemes influence physician behavior and clinical management, but evidence on their overall impact on primary care quality remains limited and raises concerns.
Area of Science:
- Health Services Research
- Primary Care Medicine
- Healthcare Policy
Background:
- Pay for performance (P4P) schemes are increasingly adopted in primary care.
- Concerns exist regarding the impact of P4P on the quality of care provided.
- The Quality and Outcomes Framework (QOF) is a notable example of a P4P scheme.
Purpose of the Study:
- To review international evidence on the relationship between P4P schemes and quality improvement in primary care.
- To provide a concise overview of current research findings.
Main Methods:
- Conducted a literature search across relevant databases.
- Included reference lists from retrieved articles.
- Incorporated findings from two recent systematic reviews on P4P schemes.
Main Results:
- Evidence on P4P's effect on quality is currently limited.
- P4P schemes can alter physician behavior and improve clinical disease management.
- Potential negative impacts on overall quality of care warrant concern.
Conclusions:
- P4P schemes require broader definitions of quality beyond incentivized clinical processes.
- The translation of improved clinical processes into enhanced patient experience and outcomes is not clearly established.
- Further consideration of comprehensive quality metrics is needed for effective P4P implementation.
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