Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Unit:Quality Measurement and Improvement
Lecture:Role of IT and informatics
Results of current approaches to quality assessment
Slide content:English Quality and Outcomes Framework (QOF) P4P program that ties 25% of pay to 129 quality indicators Initial assumption In England was 75% achievement, but it ended up being 97%, which increased costs (Doran et al., 2006) Most quality improvement occurred during pre-evaluation period and has since leveled out (Campbell et al., 2009) Other findings of note Ability to exclude patients in measures has not led to gaming of system (Doran et al., 2008) Major unintended consequence has been excess focus on EHR and prompts for quality measures (McDonald & Roland, 2009) Gap for care in more deprived areas has been reduced (Ashworth, Medina, & Morgan, 2009) 12
Slide notes:The U.S. health care system is moving away from the traditional fee-for-service model (payment regardless of patient outcomes or quality) and toward a pay-for-performance (P4P [P-for-P]) model that links provider payment to the patients outcome of care. The accountable care organization (ACO) is one model in the United States that supports P4P based on the results of patient care outcomes demonstrated by all providers across the patient care continuum. Although some have failed, ACOs have explored ways to change the current provider reimbursement methodology under health care payment reform. The English Quality and Outcomes Framework is a P4P program that ties twenty-five percent of the pay for general practitioners in England to their performance on one hundred twenty-nine quality indicators. The initial assumption was that there would be about seventy-five percent achievement, but there actually has been about ninety-seven percent achievement, which has ended up increasing the cost of the program because the targets for higher quality care were met by most physicians. Another finding is that most of the quality improvement occurred as the program was starting and has since leveled off. Of note is that one of the major unintended consequences of this program has been its excess focus on the EHR and all its prompts for quality measures. On a positive note, another study found that the quality gaps in care for more deprived areas has been reduced. 12