While the use of pay for performance as a quality improvement tool in health care is increasing, little is known about the impact of these programs on the quality of care delivered to patients with multiple conditions. Pay for performance schemes, such as the Quality and Outcomes Framework in the UK, could impact the quality of care delivered to patients with complex medical problems in several ways. A study published by myself and colleagues in the Journal of the Royal Society of Medicine suggested that introduction of pay-for-performance in primary care in the UK has not had a negative impact on the quality of care delivered to patients with multiple medical conditions. Rather, patients with co-morbid medical conditions seem to have benefited more than those without co-morbidity. This is reassuring given that previous studies have found that patients with multiple medical conditions are more likely to be excluded from performance reporting in pay for performance programs. Our findings provide no support for setting lower treatment targets for patients with multiple conditions within quality improvement programs and pay-for-performance schemes. This is important given that the longer-term benefits of good diabetes control are now firmly established and that associated health gain may be greatest in high-risk groups with existing co-morbid conditions such as coronary heart disease and hypertension.
As part of a session on primary care data in the Health Informatics module on the Imperial Master of Public Health Programme, I asked students to work in two groups to present arguments for and against the NHS Care.Data programme. Care.Data is an NHS programme that will extract data from the medical records held by general practitioners (GPs) in England. The Care.Data programme takes advantage of the very high level of use of electronic medical records by GPs in England. After extraction, data will be uploaded to the NHS Health and Social Care Information Centre (HSCIC). The data will then be used for functions such as health care planning, monitoring disease patterns and research. The programme has been controversial with proponents arguing that the programme will bring many benefits for the NHS and the population of England; and opponents arguing it is a major breach of privacy. You can view the two presentations to help inform you further about these arguments: Arguments fo...
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