Six of the seven studies showed positive but modest effects on quality of care for some primary outcome measures , but not all .
The use of financial incentives to reward PCPs for improving the quality of primary healthcare services is growing .
However , there is insufficient evidence to support or not support the use of financial incentives to improve the quality of primary health care .
BACKGROUND The use of blended payment schemes in primary care , including the use of financial incentives to directly reward ' performance ' and ' quality ' is increasing in a number of countries .
There are many examples in the US , and the Quality and Outcomes Framework ( QoF ) for general practitioners ( GPs ) in the UK is an example of a major system-wide reform .
Despite the popularity of these schemes , there is currently little rigorous evidence of their success in improving the quality of primary health care , or of whether such an approach is cost-effective relative to other ways to improve the quality of care .
OBJECTIVES The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians ( PCPs ) and to identify : i ) the different types of financial incentives that have improved quality ; ii ) the characteristics of patient population s for whom quality of care has been improved by financial incentives ; and iii ) the characteristics of PCPs who have responded to financial incentives .
Identifying predictors of high quality care in English general practice: observational study
Abstract Objectives : To assess variation in the quality of care in general practice and identify factors associated with high quality care . Design : Observational study . Setting : Stratified r and om sample of 60 general practice s in six areas of Engl and . Outcome measures : Quality of management of chronic disease ( angina , asthma in adults , and type 2 diabetes ) and preventive care ( rates of uptake for immunisation and cervical smear ) , access to care , continuity of care , and interpersonal care  ( general practice assessment survey ) . Multiple logistic regression with multilevel modelling was used to relate each of the outcome variables to practice size , routine booking interval for consultations , socioeconomic deprivation , and team climate . Results : Quality of clinical care varied substantially , and access to care , continuity of care , and interpersonal care varied moderately . Scores for asthma , diabetes , and angina were 67 % , 21 % , and 17 % higher in practice s with 10 minute booking intervals for consultations compared with practice s with five minute booking intervals . Diabetes care was better in larger practice s and in practice s where staff reported better team climate . Access to care was better in small practice s. Preventive care was worse in practice s located in socioeconomically deprived areas . Scores for satisfaction , continuity of care , and access to care were higher in practice s where staff reported better team climate . Conclusions : Longer consultation times are essential for providing high quality clinical care . Good teamworking is a key part of providing high quality care across a range of areas and may need specific support if quality of care is to be improved . Additional support is needed to provide preventive care to deprived population s. No single type of practice has a monopoly on high quality care : different types of practice may have different strengths . What is already known on this topic Quality of care varies in virtually all aspects of medicine that have been studied Most studies look at quality of care from a single perspective or for a single condition What this study adds Quality of care varies for both clinical care and assessment s by patients of access and interpersonal care Practice s with longer booking intervals provide better management of chronic disease ; preventive care is less good in practice s in deprived areas No single type of practice has a monopoly on high quality care — small practice s provide better access but poorer diabetes care Good team climate reported by staff is associated with a range of aspects of high quality
Six of the seven studies showed positive but modest effects on quality of care for some primary outcome measures , but not all .
The use of financial incentives to reward PCPs for improving the quality of primary healthcare services is growing .
However , there is insufficient evidence to support or not support the use of financial incentives to improve the quality of primary health care .
BACKGROUND The use of blended payment schemes in primary care , including the use of financial incentives to directly reward ' performance ' and ' quality ' is increasing in a number of countries .
There are many examples in the US , and the Quality and Outcomes Framework ( QoF ) for general practitioners ( GPs ) in the UK is an example of a major system-wide reform .
Despite the popularity of these schemes , there is currently little rigorous evidence of their success in improving the quality of primary health care , or of whether such an approach is cost-effective relative to other ways to improve the quality of care .
OBJECTIVES The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians ( PCPs ) and to identify : i ) the different types of financial incentives that have improved quality ; ii ) the characteristics of patient population s for whom quality of care has been improved by financial incentives ; and iii ) the characteristics of PCPs who have responded to financial incentives .