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Related Concept Videos

Primary Healthcare Services01:30

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Primary care promotes wellness and prevents disease. This care includes health promotion, education, protection (such as immunizations), early disease screening, and environmental considerations. Settings providing this type of healthcare include physician offices, public health clinics, school nursing, and community health nursing.
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At the different levels of the healthcare system, we see varying methods of healthcare used. These methods include managed care systems, case management, and primary healthcare.
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  6. Effect Of Uk Quality And Outcomes Framework Pay-for-performance Programme On Quality Of Primary Care: Systematic Review With Quantitative Synthesis.
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  6. Effect Of Uk Quality And Outcomes Framework Pay-for-performance Programme On Quality Of Primary Care: Systematic Review With Quantitative Synthesis.

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Effect of UK Quality and Outcomes Framework pay-for-performance programme on quality of primary care: systematic review with quantitative synthesis.

Leonard Ho1, Stewart W Mercer2, David Henderson3

  • 1NIHR Health Determinants Research Collaboration Aberdeen, Aberdeen, UK.

BMJ (Clinical Research Ed.)
|June 25, 2025

View abstract on PubMed

Summary
This summary is machine-generated.

Financial incentives in the UK Quality and Outcomes Framework improved care quality at one year but inconsistently at three years. Incentive withdrawal reversed these gains, often exceeding initial improvements.

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Area of Science:

  • Health Services Research
  • Healthcare Policy
  • Quality Improvement

Background:

  • The UK's Quality and Outcomes Framework (QOF) introduced financial incentives to improve primary care quality.
  • The impact of these pay-for-performance incentives on quality of care over time requires systematic evaluation.

Purpose of the Study:

  • To systematically review the impact of introducing and withdrawing financial incentives within the QOF on the quality of care.
  • To assess the one and three-year effects of these financial incentives on healthcare quality.

Main Methods:

  • A systematic review incorporating quantitative synthesis of data from eligible studies.
  • Searched multiple databases (MEDLINE, Embase, CINAHL, PsycINFO, Scopus) from January 2004 to September 2024.
  • Utilized interrupted time series analysis for quantitative synthesis, assessing risk of bias with the Mixed Methods Assessment Tool.

Main Results:

  • Incentive introduction improved recorded quality at one year (median change 6.1 pp) but inconsistently at three years (median change 0.7 pp).
  • Incentive withdrawal decreased recorded quality at one year (median change -10.7 pp) and three years (median change -12.8 pp).
  • Impact varied by indicator type, with complex processes like diabetes foot screening showing larger changes than simple processes or outcomes.

Conclusions:

  • QOF financial incentives improved quality of care at one year, but this effect diminished and became inconsistent by three years.
  • Withdrawal of incentives led to a reduction in quality, often negating or exceeding the gains achieved during incentivisation.
  • The findings suggest that sustained quality improvement requires ongoing strategies beyond temporary financial incentives.