Will changes in primary care improve health outcomes? Modelling the impact of financial incentives introduced to improve quality of care in the UK

BackgroundGPs often act as gatekeepers, authorising patients’ access to specialty care. Gatekeeping is frequently perceived as lowering health service use and health expenditure. However, there is little evidence suggesting that gatekeeping is more beneficial than direct access in terms of patient- and health-related outcomes.AimTo establish the impact of GP gatekeeping on quality of care, health use and expenditure, and health outcomes and patient satisfaction.Design and settingA systematic review.MethodThe databases MEDLINE, PreMEDLINE, Embase, and the Cochrane Library were searched for relevant articles using a search strategy. Two authors independently screened search results and assessed the quality of studies.ResultsElectronic searches identified 4899 studies (after removing duplicates), of which 25 met the inclusion criteria. Gatekeeping was associated with better quality of care and appropriate referral for further hospital visits and investigation. However, one study reported unfavourable outcomes for patients with cancer under gatekeeping, and some concerns were raised about the accuracy of diagnoses made by gatekeepers. Gatekeeping resulted in fewer hospitalisations and use of specialist care, but inevitably was associated with more primary care visits. Patients were less satisfied with gatekeeping than direct-access systems.ConclusionGatekeeping was associated with lower healthcare use and expenditure, and better quality of care, but with lower patient satisfaction. Survival rate of patients with cancer in gatekeeping schemes was significantly lower than those in direct access, although primary care gatekeeping was not otherwise associated with delayed patient referral. The long-term outcomes of gatekeeping arrangements should be carefully studied before devising new gatekeeping policies.

Download Full-text

The impact of a needs‐based model of care on accessibility and quality of care within children's mental health services: A qualitative investigation of the UK i‐THRIVE Programme

Child Care Health and Development ◽

10.1111/cch.12855 ◽

2021 ◽

Author(s):

Joanna Farr ◽

Anna Moore ◽

Hilary Bruffell ◽

Jacqueline Hayes ◽

John P. Rae ◽

...

Keyword(s):

Mental Health ◽

Quality Of Care ◽

Mental Health Services ◽

Health Services ◽

Children's Mental Health ◽

Qualitative Investigation ◽

Model Of Care ◽

The Uk ◽

The Impact

Download Full-text

Physician beliefs about the impact of meaningful use of the EHR

Applied Clinical Informatics ◽

10.4338/aci-2014-05-ra-0050 ◽

2014 ◽

Vol 05 (03) ◽

pp. 789-801 ◽

Cited By ~ 13

Author(s):

D.Y. Ting ◽

M. Healey ◽

S.R. Lipsitz ◽

A.S. Karson ◽

J. S. Einbinder ◽

...

Keyword(s):

Quality Of Care ◽

Primary Care Physicians ◽

Meaningful Use ◽

The United States ◽

Improve Quality ◽

Cross Sectional ◽

Incentive Program ◽

Physician Beliefs ◽

The Impact

SummaryBackground: As adoption and use of electronic health records (EHRs) grows in the United States, there is a growing need in the field of applied clinical informatics to evaluate physician perceptions and beliefs about the impact of EHRs. The meaningful use of EHR incentive program provides a suitable context to examine physician beliefs about the impact of EHRs.Objective: Contribute to the sparse literature on physician beliefs about the impact of EHRs in areas such as quality of care, effectiveness of care, and delivery of care.Methods: A cross-sectional online survey of physicians at two academic medical centers (AMCs) in the northeast who were preparing to qualify for the meaningful use of EHR incentive program.Results: Of the 1,797 physicians at both AMCs who were preparing to qualify for the incentive program, 967 completed the survey for an overall response rate of 54%. Only 23% and 27% of physicians agreed or strongly agreed that meaningful use of the EHR will help them improve the care they personally deliver and improve quality of care respectively. Physician specialty was significantly associated with beliefs; e.g., 35% of primary care physicians agreed or strongly agreed that meaningful use will improve quality of care compared to 26% of medical specialists and 21% of surgical specialists (p=0.009). Satisfaction with outpatient EHR was also significantly related to all belief items.Conclusions: Only about a quarter of physicians in our study responded positively that meaningful use of the EHR will improve quality of care and the care they personally provide. These findings are similar to and extend findings from qualitative studies about negative perceptions that physicians hold about the impact of EHRs. Factors outside of the regulatory context, such as physician beliefs, need to be considered in the implementation of the meaningful use of the EHR incentive program.Citation: Emani S, Ting DY, Healey M, Lipsitz SR, Karson AS, Einbinder JS, Leinen L, Suric V, Bates DW. Physician beliefs about the impact of meaningful use of the EHR: A cross-sectional study. Appl Clin Inf 2014; 5: 789–801http://dx.doi.org/10.4338/ACI-2014-05-RA-0050

Download Full-text

The Impact of Contract Primary Care on Health Care Expenditures and Quality of Care

Medical Care Research and Review ◽

10.1177/1077558707313034 ◽

2007 ◽

Vol 65 (3) ◽

pp. 300-314 ◽

Cited By ~ 5

Author(s):

Chuan-Fen Liu ◽

Michael K. Chapko ◽

Mark W. Perkins ◽

John Fortney ◽

Matthew L. Maciejewski

Keyword(s):

Primary Care ◽

Health Care ◽

Quality Of Care ◽

Health Care Expenditures ◽

The Impact

Download Full-text

The impact of an integrated hospital-community medical information system on quality of care and medical service utilisation in primary-care clinics

Informatics for Health and Social Care ◽

10.3109/17538157.2010.535130 ◽

2011 ◽

Vol 36 (2) ◽

pp. 63-74 ◽

Cited By ~ 11

Author(s):

Nurit Nirel ◽

Bruce Rosen ◽

Assaf Sharon ◽

Hadar Samuel ◽

Arnon D. Cohen

Keyword(s):

Primary Care ◽

Information System ◽

Quality Of Care ◽

Medical Service ◽

Medical Information ◽

Medical Information System ◽

Service Utilisation ◽

Primary Care Clinics ◽

The Impact

Download Full-text

Effectiveness of UK provider financial incentives on quality of care: a systematic review

British Journal of General Practice ◽

10.3399/bjgp17x693149 ◽

2017 ◽

Vol 67 (664) ◽

pp. e800-e815 ◽

Cited By ~ 10

Author(s):

Rishi Mandavia ◽

Nishchay Mehta ◽

Anne Schilder ◽

Elias Mossialos

Keyword(s):

Systematic Review ◽

Health Care ◽

Quality Of Care ◽

Quality Of Health Care ◽

Financial Incentives ◽

Healthcare Quality ◽

Standards Of Care ◽

Positive Effects ◽

The Uk

BackgroundProvider financial incentives are being increasingly adopted to help improve standards of care while promoting efficiency.AimTo review the UK evidence on whether provider financial incentives are an effective way of improving the quality of health care.Design and settingSystematic review of UK evidence, undertaken in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations.MethodMEDLINE and Embase databases were searched in August 2016. Original articles that assessed the relationship between UK provider financial incentives and a quantitative measure of quality of health care were included. Studies showing improvement for all measures of quality of care were defined as ‘positive’, those that were ‘intermediate’ showed improvement in some measures, and those classified as ‘negative’ showed a worsening of measures. Studies showing no effect were documented as such. Quality was assessed using the Downs and Black quality checklist.ResultsOf the 232 published articles identified by the systematic search, 28 were included. Of these, nine reported positive effects of incentives on quality of care, 16 reported intermediate effects, two reported no effect, and one reported a negative effect. Quality assessment scores for included articles ranged from 15 to 19, out of a maximum of 22 points.ConclusionThe effects of UK provider financial incentives on healthcare quality are unclear. Owing to this uncertainty and their significant costs, use of them may be counterproductive to their goal of improving healthcare quality and efficiency. UK policymakers should be cautious when implementing these incentives — if used, they should be subject to careful long-term monitoring and evaluation. Further research is needed to assess whether provider financial incentives represent a cost-effective intervention to improve the quality of care delivered in the UK.

Download Full-text

The Impact of Primary Care Dual-Management on Quality of Care

Journal of Primary Care & Community Health ◽

10.1177/2150131911411194 ◽

2011 ◽

Vol 3 (1) ◽

pp. 11-16 ◽

Cited By ~ 1

Author(s):

Peter J. Kaboli ◽

Daniel M. Shivapour ◽

Michael S. Henderson ◽

Areef Ishani ◽

Mary E. Charlton

Keyword(s):

Primary Care ◽

Quality Of Care ◽

Hemoglobin A1c ◽

Ldl Cholesterol ◽

Primary Care Providers ◽

Care Quality ◽

Care Providers ◽

Dual Management ◽

The Impact

Background: Discontinuity is common in US healthcare. Patients access multiple systems of care and in the nation’s largest integrated healthcare system, Veteran’s Administration (VA) patients frequently use non-VA primary care providers. The impact of this “dual-management” on quality is unknown. The authors’ objective was to identify dual-management and associations with markers of care quality for hypertension and associated conditions. Methods: Data was collected via surveys and chart reviews of primary care patients with hypertension from six VA clinics in Iowa and Minnesota. Clinical measures abstracted included the following: goal blood pressure (BP) and use of guideline-concordant therapy, low-density lipoprotein (LDL) cholesterol, hemoglobin A1C, and body mass index (BMI). Dual-management data was obtained through self-report. Results: Of 189 subjects (mean age = 66), 36% were dual-managed by non-VA providers. There was no difference in hypertension quality of care measures by dual-management status. A total of 51% were at BP goal and 58% were on guideline-concordant therapy. Dual-managed patients were more likely to use thiazide diuretics (43% vs 29%; P = .03) and angiotensin receptor blockers (13% vs 3%; P < .01), but less likely to use angiotensin-converting enzyme inhibitors (43% vs 61%; P = .02). There was no difference in LDL cholesterol (97.1 mg/dl vs 100.1 mg/dl; P = .55), hemoglobin A1C (7% vs 6%; P = .74), or BMI (29.8 vs 30.9; P = .40) for dual-managed versus VA managed patients, respectively. Conclusions: Although dual-management may decrease continuity, VA/private sector dual-management did not impact quality of care, though some medication differences were observed. With the high prevalence of dual-management, future work should further address quality and evaluate redundancy of services.

Download Full-text