Quality of clinical primary care and targeted incentive payments: an observational study

Nicholas Steel, Susan Maisey, Allan Clark, Robert Fleetcroft, Amanda Howe

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Background: Payments for recorded evidence of quality of clinical care in UK general practices were introduced in 2004.

Aim: To examine the relationship between changes in recorded quality of care for four common chronic conditions from, 2003 to 2005, and the payment of incentives.

Design of study: Retrospective observational study comparing incentivised and non-incentivised indicators of quality of care.

Setting: Eighteen general practices in England.

Method: Medical records were examined for 1156 patients. The percentage of eligible quality indicators achieved for each patient was assessed in 2003 and 2005. Twenty-one quality indicators referred to asthma and hypertension: six subject to and 15 not subject to incentive payments. Another 15 indicators referred to depression and osteoarthritis which were not subject to incentive payments.

Results: A significant increase occurred for the six indicators linked to incentive payments: from 75% achieved in 2003 to 91% in 2005 (change = 16%, 95% confidence interval [CI] = 10 to 22%, P<0.01). A significant increase also occurred for 15 other indicators linked to ‘incentivised conditions’; 53 to 64% (change = 11%, 95% CI = 6 to 15%, P<0.01). The ‘non-incentivised conditions’ started at a lower achievement level, and did not increase significantly: 35 to 36% (change = 2%, 95% CI = −1 to 4%, P = 0.19).

Conclusion: The introduction of financial incentives was associated with substantial apparent quality improvement for incentivised conditions. For non-incentivised conditions, quality did not appear to improve. Patients with non-incentivised conditions may be at risk of poorer quality care.
Original languageEnglish
Pages (from-to)449-454
Number of pages6
JournalBritish Journal of General Practice
Issue number539
Publication statusPublished - 2007

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