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The Health Foundation
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Add the result to your basket Make a suggestion Refine your search Apply to external sourcesDo quality improvements in primary care reduce secondary care costs? / Stephen Martin / London [United Kingdom] : The Health Foundation (2010)
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Languages : English (eng)
Descriptors: Indexation
Cost-effectiveness analysis ; Great Britain ; Health Care Costs ; Outcome Assessment (Health Care) ; Primary Health Care ; Quality improvement ; Quality of Health Care
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W 84.4 Quality of health care (General)Abstract: The introduction in 2004 of the Quality and Outcomes Framework (QOF) in UK general practice represents one of the most ambitious efforts to measure and incentivise quality improvements in primary care. This report takes advantage of a large database of over 50 million English citizens to determine whether the levels of QOF attainment in general practices have led to improvements in two major outcomes: mortality and the costs of hospital inpatient and outpatient use. Our findings are that primary care performance improvements are associated with some modest but measurable improvements in subsequent outcomes and costs. Contents note: CHAPTER 1 Introduction 1 -- 1.1 GP contracts 1 -- 1.2 Quality indicators 1 -- 1.3 Practice QOF scores and hospital admission rates 2 -- 1.4 Drawing on a new dataset 2 -- 1.5 Report structure 3 -- CHAPTER 2 Theoretical background 4 -- 2.1 Effectiveness or cost-effectiveness? 4 -- 2.2 Scope of this study 4 -- 2.3 A mathematical model 4 -- CHAPTER 3 The Quality and Outcomes Framework (QOF) 6 -- 3.1 QOF 2004/05 and 2005/06 6 -- 3.2 QOF 2006/07 and 2007/08 11 -- CHAPTER 4 The dataset and the development of a basic model of hospital costs 16 -- 4.1 A model for patient expenditure 16 -- 4.2 The estimation sample 18 -- 4.3 The estimation method 18 -- 4.4 Derivation of a parsimonious model for hospital expenditure 18 -- CHAPTER 5 Variants of the base model, and further analysis 23 -- 5.1 Updating the QOF stroke achievement score 23 -- 5.2 Deriving a new parsimonious model with a binary (patient died) dependent variable 26 -- 5.3 Deriving parsimonious models for individual disease areas 28 -- 5.4 Panel data estimation 33 -- CHAPTER 6 Conclusions 40 -- 6.1 Base model findings 40 -- 6.2 Panel data model findings 40 -- 6.3 Scope for future research 41 -- 6.4 QOF – material but limited gains? 41 -- ENDNOTES 42 -- REFERENCES 45 -- APPENDIX: Grounds for exception reporting patients 46 Link for e-copy: http://www.health.org.uk/media_manager/public/75/QOFnew.pdf Format of e-copy: PDF [Open Access] Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2458 Hold
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Barcode Call number Media type Location Section Status 10273-02201 W 84. 4 / MAR Report KCE Library (10.124) Available
ISBN : 978-1-906461-17-1 : € 0,00
Languages : English (eng)
Descriptors: Indexation
Cost-effectiveness analysis ; England ; Health Care Costs ; Quality improvement ; Review Literature
Classification
W 84.4 Quality of health care (General)Abstract: This report reviews the evidence of whether improving quality can also save money for health service providers. It explores the cost saving potential of initiatives to improve quality and the barriers to success. Contents note: Foreword vii -- Abstract ix -- Executive summary xi -- Outline of the review xi -- Poor quality and adverse events are common and costly xii -- Some interventions are effective, but carry costs which may exceed savings xii -- The cost and benefits of quality are spread over time and between stakeholders xiii -- Context factors influence whether a provider saves money from quality improvement xiv -- Providers would be helped by information relevant to their situation xiv -- Saving avoidable suffering may be speeded up by the business case xv -- Summary for health service providers xvii -- Does quality improvement save money for a service? xvii -- What is the actionable knowledge for service providers from the research? xviii -- How strong does the evidence need to be before we act? xviii -- How can providers ensure saving through quality improvement? xix -- PART 1: INTRODUCTION, OBJECTIVES AND METHODS 1 -- Chapter 1 Introduction 3 -- 1.1 A map of the literature 3 -- 1.1.1 Improving quality or quality improvement? 4 -- 1.1.2 The literature 5 -- Chapter 2 Concepts and terms 7 -- 2.1 Costs and savings 8 -- 2.1.1 A comment on the evidence 9 -- 2.2 Summary of conceptual distinctions made in this report 10 -- Chapter 3 Objectives, methods, and how the findings are presented 11 -- 3.1 How the research is presented to answer the questions 13 -- PART 2: EVIDENCE ABOUT COSTS AND SAVINGS 15 -- Chapter 4 Evidence of poor quality and costs 17 -- 4.1 General studies of poor quality 17 -- 4.1.1 Poor quality patient issues, dissatisfaction, complaints and negligence 17 -- Claims -- 4.1.2 Overuse, underuse, misuse and waste 18 -- 4.2 Adverse events and quality costs: general studies 18 -- 4.2.1 General adverse events studies 18 -- 4.3 Categories of adverse events: potential savings 20 -- 4.3.1 Hospital-acquired infections 20 -- 4.3.2 Adverse drug events 20 -- 4.3.3 Adverse events associated with surgery 21 -- 4.3.4 Pressure ulcers 22 -- 4.3.5 Patient falls 22 -- 4.3.6 Adverse events associated with ‘failure to rescue’ 22 -- 4.3.7 Communication and coordination failures 23 -- 4.3.8 Hospital discharge communications 23 -- 4.3.9 Other adverse events 24 -- 4.4 Conclusions: costs of poor quality and adverse events 24 -- Chapter 5 Solutions: evidence of effectiveness of interventions to reduce poor 27 -- quality, and their costs -- 5.1 Introduction 27 -- 5.1.1 ‘Reader alerts’ 27 -- 5.2 General improvement: evidence of effectiveness and intervention costs 28 -- 5.2.1 Nurse staffing 29 -- 5.2.2 Intensive care 30 -- 5.2.3 Interventions to reduce adverse drug events 30 -- 5.2.4 Computer solutions 30 -- 5.2.5 Improvements to communication and coordination: effectiveness 32 -- 5.2.6 Other interventions 33 -- 5.3 Quality improvement interventions: evidence of effectiveness and 35 -- intervention costs -- 5.3.1 Total quality management 36 -- 5.3.2 Continuous quality improvement projects 36 -- 5.3.3 Plan-Do-Study-Act cycle 37 -- 5.3.4 Statistical process control 37 -- 5.3.5 Process redesign, re-engineering, and Lean manufacturing 37 -- 5.3.6 Six Sigma 38 -- 5.3.7 Theory of constraints and mass customisation 39 -- 5.3.8 What is a ‘quality improvement intervention’ and what is an 39 -- ‘intervention to improve quality’? -- Chapter 6 Conclusions: savings to providers from improving quality 41 -- PART 3: CHALLENGES AND ENABLERS TO SAVING BY IMPROVING QUALITY 43 -- Chapter 7 The financial issues 45 -- 7.1 Features of finance systems 45 -- 7.1.1 Routine service payment schemes 45 -- 7.1.2 Penalties 45 -- 7.1.3 Incentives 46 -- 7.2 Costs and savings 46 -- 7.3 Conclusions 49 -- Chapter 8 The support issues 51 -- 8.1 Non-financial barriers to effective improvement 51 -- 8.1.1 Information 52 -- 8.1.2 Uncertainty and skill deficiencies 52 -- 8.1.3 Other urgent demands 52 -- 8.2 Enabling factors for improvement 53 -- 8.3 Financial and resource barriers to improvement 53 -- 8.3.1 Cost displacement (‘revenue displacement’) 53 -- 8.3.2 Investment resources and high initial intervention cost (‘capital costs’) 54 -- 8.3.3 Savings displacement 54 -- 8.4 Financial and resource enablers for improvement 54 -- 8.4.1 Provider bears the cost of poor quality 54 -- 8.4.2 Investment and capacity costs 55 -- 8.5 Conclusions 56 -- PART 4: FUTURE RESEARCH AND CONCLUSIONS 57 -- Chapter 9 Future research 59 -- 9.1 Future research 59 -- 9.1.1 Overall, how well does the research provide answers to the review 59 -- questions and where are the gaps? -- 9.1.2 Other observations about the research 61 -- 9.1.3 Future types of research needed 61 -- 9.1.4 Future research in the UK: proposed subjects 62 -- 9.2 Conclusions 63 -- APPENDICES AND BIBLIOGRAPHY 65 -- Appendix 1a Definition of terms used in the report 67 -- Appendix 1b Other common definitions and meanings 69 -- Appendix 2 Financial incentive schemes for improvement 71 -- 2.1 An overview of the relevant literature 71 -- 2.2 Financial incentives and penalties 72 -- 2.2.1 What are some of the schemes in operation? 72 -- 2.2.2 Pay for performance 74 -- 2.2.3 No pay for never events 75 -- 2.2.4 Discussion of schemes 76 -- 2.2.5 Do financial interventions, such as payments or other financial 76 -- rewards to providers or patients, improve safety? -- 2.2.6 Relevant literature on issues related to financial incentives for safety 76 -- 2.2.7 Information technology and financial incentives 78 -- Appendix 3 Context for quality improvement 79 -- 3.1 Contexts for successful implementation 79 -- 3.1.1 Safety culture 80 -- 3.1.2 Protection for and accountability of healthcare providers 80 -- 3.1.3 Context factors – general research 81 -- 3.1.4 Specific interventions – evidence of necessary conditions 80 -- Bibliography 83 Link for e-copy: http://www.health.org.uk/public/cms/75/76/313/572/Does%20improving%20quality%20s [...] Format of e-copy: PDF [Open Access] (769 Kb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2513 Hold
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Barcode Call number Media type Location Section Status 10273-02208 W 84.4 / VRE Report KCE Library (10.124) Available
ISBN : 978-1-906461-14-0 : € 0,00
Languages : English (eng)
Descriptors: Indexation
Outcome Assessment (Health Care) ; Patient Care Team ; Quality improvement ; Review
Classification
W 84.4 Quality of health care (General)Abstract: This systematic review groups studies according to the particular objectives of the teams. By aggregating the results to these subgroups, the authors aimed to draw some headline measures about the effectiveness of different types of teams. In addition, determinants for team effectiveness were collected. Contents note: Executive summary 5 -- Project background 7 -- Introduction 8 -- Definition of ‘team’ 8 -- Conceptual framework 9 -- Objectives 11 -- Methods 12 -- Data sources and searches 12 -- Study selection 12 -- Data extraction procedure 14 -- Quality assessment 15 -- Data synthesis 15 -- Results 16 -- Identification of evidence 16 -- Description of studies 16 -- Types of team intervention 17 -- Participants and settings 17 -- Methodological quality of the studies 17 -- 1A. Interventions: enhanced clinical expertise (n = 8) 17 -- 1B. Evidence: enhanced clinical expertise 19 -- 2A. Interventions: improved coordination (n = 5) 20 -- 2B. Evidence: improved coordination 22 -- 3A. Interventions: enhanced clinical expertise and coordination (n = 10) 22 -- 3B. Evidence: enhanced clinical expertise and coordination 25 -- 4. Description of interventions and results derived from review studies 27 -- 5. Team characteristics as determinants of effect 28 -- Table 2: Summary of the evidence and intervention characteristics 29 -- Discussion 39 -- Discussion of main findings 39 -- Methodological considerations 40 -- Implications for health policy 41 -- Implications for research 43 -- Appendix A: Search strategy for QQUIP teams review in PubMed 44 -- Appendix B: Search strategy and results per database 45 -- Appendix C: Data collection forms 50 -- Appendix D: Excluded studies and reason for exclusion 51 -- Appendix E: Methodological quality studies 54 -- Appendix F: Results per study 56 -- References 68 Link for e-copy: http://www.health.org.uk/public/cms/75/76/313/579/Patient%20Care%20Teams.pdf?rea [...] Format of e-copy: PDF [Open Access] Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2462 Hold
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Barcode Call number Media type Location Section Status 10273-02203 W 84.4 / BOS Report KCE Library (10.124) Available
ISSN : 978-1-60646-115-7 : € 0,00
Languages : English (eng)
Descriptors: Classification
W 76 Health manpower and services, distribution and characteristics
Indexation
England ; Health Care ; Outcome Assessment (Health Care) ; Quality of Health Care ; Review LiteratureAbstract: Revision of professional roles and quality improvement: a review of the evidence, considers the impact of professional role revision on quality of care and outcomes. It focuses on two types of changes to professional roles:
* Substitution – exchanging one type of professional for another.
* Supplementation – extending the range of service provision within one health delivery system.
This report focuses on the revision of roles between doctors and:
* advanced practice nurses such as nurse practitioners, specialist nurses, clinical nurses and practice nurses
* physician assistants pharmacists
* allied healthcare professionals such as physical therapists (referred to as physiotherapists in this review), speech and language therapists, dietitians and paramedics.
Professional role revision has a number of aims: to reduce the medical workload; to increase capacity and extend the range of services available to patients; to improve the quality of care; and/or to reduce costs.
Our report finds that there is no detrimental effect of revising or extending the roles of non-medical professionals, and in some cases there is a positive effect on the quality of patient care. Gains in service efficiency may be achieved if doctors stop providing the services that are transferred to other health professionals and instead invest their time in activities that they alone can perform.Contents note: List of figures and tables iii -- Executive summary v -- 1. Background 1 -- 1.1 Introduction 1 -- 1.1.1 Factors driving revision of professional roles 1 -- 1.1.2 Terms and definitions 2 -- 1.1.3 Objective 3 -- 1.2 Focus 3 -- 1.2.1 Types of non-physician clinicians 3 -- 1.2.2 Number of non-physician clinicians 5 -- 1.2.3 Types of roles: a framework 6 -- 1.3 Format of the report 7 -- 2. Methods 8 -- 2.1 Outcomes of interest 8 -- 2.2 Types of studies 9 -- 2.3 Search 9 -- 2.4 Study inclusion 10 -- 2.5 Data extraction 11 -- 2.6 Type of role revision 12 -- 2.7 Validity assessment 12 -- 2.8 Data synthesis 13 -- 3. Results 14 -- 3.1 Trial flow 14 -- 3.2 Methodological quality and strength of evidence 15 -- 3.3 Evidence for nurse role revision 16 -- 3.3.1 Structural indicators 31 -- 3.3.2 Process indicators 32 -- 3.3.3 Outcome indicators 39 -- 3.3.4 Conclusions 43 -- 3.4 Evidence for physician assistant role revision 43 -- 3.4.1 Structural indicators 46 -- 3.4.2 Process indicators 46 -- 3.4.3 Outcome indicators 47 -- 3.4.4 Conclusions 47 -- 3.5 Evidence for allied health professional role revision 48 -- 3.5.1 Structural indicators 51 -- 3.5.2 Process indicators 51 -- 3.5.3 Outcome indicators 52 -- 3.5.4 Conclusions 52 -- 3.6 Evidence for pharmacist role revision 52 -- 3.6.1 Structural indicators 53 -- 3.6.2 Process indicators 57 -- 3.6.3 Outcome indicators 57 -- 3.6.4 Conclusions 58 -- 3.7 Evidence for mixed group of non-physician clinicians role revision 58 -- 3.7.1 Structural indicators 58 -- 3.7.2 Process indicators 62 -- 3.7.3 Outcome indicators 62 -- 3.7.4 Conclusions 63 -- 4. Conclusion and discussion 64 -- 4.1 Conclusion 64 -- 4.2 Discussion 64 -- 4.2.1 Methodological strengths and limitations 64 -- 4.2.2 Implications for practice and health policy 66 -- 4.2.3 Implications for research 66 -- 5. References 68 -- Appendices 75 -- Appendix 1. Search strategy 75 -- Appendix 2. References included in studies; unique and duplicate references 77 Link for e-copy: http://www.health.org.uk/public/cms/75/76/313/582/Revision%20of%20professional%2 [...] Format of e-copy: PDF [Open Access] (1 Mb) Record link: https://kce.docressources.info/index.php?lvl=notice_display&id=2514 Hold
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Barcode Call number Media type Location Section Status 10273-02209 W 76 / LAU Report KCE Library (10.124) Available
