Pay-for-Performance incentives for specialised services in England: a mixed methods evaluation.

Area of Science:

• Healthcare management
• Health services research
• Quality improvement initiatives

Background:

• The English NHS introduced the Prescribed Specialised Services Commissioning for Quality and Innovation (PSS CQUIN) in 2013/2014 for rare and complex conditions.
• This study evaluates PSS CQUIN contract implementation from 2016/2017 to 2018/2019.

Purpose of the Study:

• To evaluate the effectiveness of PSS CQUIN schemes on targeted outcomes.
• To explore the complexities of contract design and programme implementation in specialised healthcare services.

Main Methods:

• A mixed-methods approach combining quantitative (difference-in-differences with propensity score matching) and qualitative (semi-structured interviews, focus groups) analyses.
• Quantitative analysis assessed impacts on targeted outcomes and costs.
• Qualitative analysis explored implementation challenges using constant comparative method.

Main Results:

• PSS CQUIN schemes demonstrated limited impact on targeted outcomes, with only one scheme showing a statistically significant improvement (7% increase in timely discharge from Adult Critical Care in trauma).
• Potential reasons for limited impact include small incentive payments, complex scheme design, and issues with ownership, contracting, and flexibility.
• No significant impact on overall quality improvements in specialised services was observed.

Conclusions:

• PSS CQUIN schemes had minimal to no effect on enhancing quality in specialised healthcare services.
• Future Pay-for-Performance programmes should consider the study's findings on incentive design and implementation strategies for greater effectiveness.