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Equity in Primary Care: Evaluating the Impact of Paying for Performance on Health Disparities

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merrill-cabrera
18 diapositives · 332 Views · Oct 26, 2014

This study, led by Tim Doran at the University of York, investigates how paying for performance in primary care affects health inequalities in England. Initiated in 2004, the program introduced 146 quality indicators aimed at chronic condition management, organizational care, and patient experience. While intended to enhance care quality, this approach raises concerns about the exclusion of inappropriate patients and whether it has effectively reduced health disparities. Analyzing data from the Quality and Outcomes Framework, the research examines its implications for equitable healthcare provision.

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Equity in Primary Care: Evaluating the Impact of Paying for Performance on Health Disparities
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  1. EQUITY IN PRIMARY CARE PAYING FOR PERFORMANCE • TIM DORAN • UNIVERSITY OF YORK

  2. HEALTH INEQUALITYIMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE

  3. HEALTH INEQUALITIES IN ENGLAND PRIMARY CARE AND HEALTH DISPARITY SOURCE:DORLING ET AL, GRIM REAPER’S ROAD MAP, BRISTOL 2008

  4. HEALTH INEQUALITYIMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE

  5. 1948: THE NATIONAL HEALTH SERVICE PRIMARY CARE AND HEALTH DISPARITY BEVERIDGE AND THE FIVE GIANTS

  6. “…at best… very unsatisfactory and at worst a positive source of public danger.” PRIMARY CARE UNDER THE NHS “Conditions are… bad enough to turn a good doctor into a bad one within a very short time.” PRIMARY CARE AND HEALTH DISPARITY SOURCE: COLLINGS, LANCET 1950; 6625: 555-585.

  7. GLYNCORRWG POPULATION 1900 64% UNSKILLED HEALTH CENTRE ‘SCREENING’ FOR BP, SMOKING, CHOLESTEROL, DIABETES, LUNG FUNCTION, BMI, ALCOHOLISM MORTALITY SMR 94 (-6%) (BLAENGWYNFI 16O) REPEALING THE INVERSE CARE LAW PRIMARY CARE AND HEALTH DISPARITY SOURCE: TUDOR HART ET AL, BMJ 1991; 302: 1509-1503.

  8. HEALTH INEQUALITYIMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE

  9. INTRODUCED 2004 (ALL UK GENERAL PRACTICES) • 146 QUALITY INDICATORS COVERING: • MANAGEMENT OF CHRONIC CONDITIONS • ORGANISATION OF CARE • PATIENT EXPERIENCE • INDICATORS WORTH 0.5-57 POINTS (TOTAL 1,000) • 1 POINT = £125 (€145) • PRACTICES EXCLUDE INAPPROPRIATE PATIENTS • ACHIEVEMENT SCORES PUBLICLY REPORTED QUALITY & OUTCOMES FRAMEWORK PRIMARY CARE AND HEALTH DISPARITY OVERVIEW OF THE QUALITY & OUTCOMES FRAMEWORK

  10. POINTS: 0-19 PAYMENT: £0-1,444 E.G.: CONTROL OF BLOOD PRESSURE LOWERTHRESHOLD UPPER THRESHOLD PERCENTAGE ACHIEVEMENT PRIMARY CARE AND HEALTH DISPARITY CHD6: PERCENTAGE OF CHD PATIENTS WITH BP ≤150/90 MMHG

  11. REPORTED ACHIEVEMENT IMPACT ON INEQUALITIES 2004/5 2005/6 2006/7 PRIMARY CARE AND HEALTH DISPARITY SOURCE:DORAN ET AL. LANCET 2008; 372: 728-736.

  12. PROCESSES OUTCOMES IMPACT ON INEQUALITIES ACHIEVEMENT DEPRIVATION QUINTILE PRIMARY CARE AND HEALTH DISPARITY DIABETES INDICATORS, BY DEPRIVATION QUINTILE

  13. ACHIEVEMENT ABOVE PREDICTED NON-INCENTIVIZED ACTIVITIES NO EFFECT 2004/5 2006/7 PRIMARY CARE AND HEALTH DISPARITY SOURCE:DORAN ET AL. BMJ 2011; 342: D3590.

  14. RELATIVE GAIN SYSTEM ADVANTAGES COMPUTING SYSTEM PRIMARY CARE AND HEALTH DISPARITY ADDITIONAL REMUNERATION COMPARED WITH SYSTEM ‘G’

  15. VIEWS OF PRACTITIONERS PRIMARY CARE AND HEALTH DISPARITY SOURCE: WEHRLI U, FUR ELISE

  16. “It's a good idea – I think it makes things tangible and quantifies things…” “…although I hate it. I do.” PRIMARY CARE AND HEALTH DISPARITY SOURCE: MCDONALD ET AL. BMJ 2007; 334: 1357-1362.

  17. QUESTIONS?PAYING FOR PERFORMANCE TIM.DORAN@YORK.AC.UK

  18. PATIENTS PER PHYSICIAN EQUITABLE CARE PROVISION? DEPRIVATION ‘DECILE’ PRIMARY CARE AND HEALTH DISPARITY DISTRIBUTION OF PRIMARY CARE PHYSICIANS (1996)