tim doran university of york
DESCRIPTION
EQUITY IN PRIMARY CARE PAYING FOR PERFORMANCE. TIM DORAN UNIVERSITY OF YORK. HEALTH INEQUALITY IMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE. HEALTH INEQUALITIES IN ENGLAND. PRIMARY CARE AND HEALTH DISPARITY. SOURCE: DORLING ET AL, GRIM REAPER’S ROAD MAP, BRISTOL 2008. - PowerPoint PPT PresentationTRANSCRIPT
TIM DORANUNIVERSITY OF YORK
EQUITY IN PRIMARY CARE
PAYING FOR PERFORMANCE
HEALTH INEQUALITYIMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE
HEALTH INEQUALITIES IN ENGLAND
SOURCE: DORLING ET AL, GRIM REAPER’S ROAD MAP, BRISTOL 2008 PRIMARY CARE AND HEALTH DISPARITY
HEALTH INEQUALITYIMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE
1948: THE NATIONAL HEALTH SERVICE
BEVERIDGE AND THE FIVE GIANTS PRIMARY CARE AND HEALTH DISPARITY
PRIMARY CARE UNDER THE NHS
SOURCE: COLLINGS, LANCET 1950; 6625: 555-585. PRIMARY CARE AND HEALTH DISPARITY
“Conditions are… bad enough to turn a good doctor into a bad one within a very short
time.”
“…at best… very unsatisfactory and at worst a positive source of public danger.”
REPEALING THE INVERSE CARE LAW
SOURCE: TUDOR HART ET AL, BMJ 1991; 302: 1509-1503. PRIMARY CARE AND HEALTH DISPARITY
GLYNCORRWGPOPULATION 190064% UNSKILLED
HEALTH CENTRE‘SCREENING’ FOR BP, SMOKING, CHOLESTEROL, DIABETES, LUNG FUNCTION, BMI, ALCOHOLISM
MORTALITY SMR 94 (-6%)(BLAENGWYNFI 16O)
HEALTH INEQUALITYIMPACT OF PRIMARY CARE PAYING FOR PERFORMANCE
QUALITY & OUTCOMES FRAMEWORK
OVERVIEW OF THE QUALITY & OUTCOMES FRAMEWORK PRIMARY CARE AND HEALTH DISPARITY
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
E.G.: CONTROL OF BLOOD PRESSURE
CHD6: PERCENTAGE OF CHD PATIENTS WITH BP ≤150/90 MMHG PRIMARY CARE AND HEALTH DISPARITY
0 3 6 9 1215182124273033363942454851545760636669727578818487909396990
2
4
6
8
10
12
14
16
18
20
Percentage achievement
PO
INTS S
CO
RED
PERCENTAGE ACHIEVEMENT
LOWER THRESHOLD
UPPER THRESHOLD
POINTS: 0-19
PAYMENT: £0-1,444
IMPACT ON INEQUALITIES
SOURCE: DORAN ET AL. LANCET 2008; 372: 728-736.
REPO
RTED
AC
HIE
VEM
EN
T
2004/5 2005/6 2006/7
PRIMARY CARE AND HEALTH DISPARITY
IMPACT ON INEQUALITIES
DIABETES INDICATORS, BY DEPRIVATION QUINTILE PRIMARY CARE AND HEALTH DISPARITY
AC
HIE
VEM
EN
T
DEPRIVATION QUINTILE
PROCESSES OUTCOMES
NON-INCENTIVIZED ACTIVITIES
SOURCE: DORAN ET AL. BMJ 2011; 342: D3590.
AC
HIE
VEM
EN
T A
BO
VE P
RED
ICTED
PRIMARY CARE AND HEALTH DISPARITY
2004/5 2006/7
NO EFFECT
SYSTEM ADVANTAGES
ADDITIONAL REMUNERATION COMPARED WITH SYSTEM ‘G’
RELA
TIV
E G
AIN
PRIMARY CARE AND HEALTH DISPARITY
COMPUTING SYSTEM
VIEWS OF PRACTITIONERS
SOURCE: WEHRLI U, FUR ELISE PRIMARY CARE AND HEALTH DISPARITY
“It's a good idea – I think it makes things tangible and quantifies things…”
“…although I hate it. I do.”
SOURCE: MCDONALD ET AL. BMJ 2007; 334: 1357-1362. PRIMARY CARE AND HEALTH DISPARITY
EQUITABLE CARE PROVISION?
PRIMARY CARE AND HEALTH DISPARITY
PATIE
NTS
PER
PH
YSIC
IAN
DEPRIVATION ‘DECILE’
DISTRIBUTION OF PRIMARY CARE PHYSICIANS (1996)