The removal of Quality and Outcomes Framework (QOF) indicators is likely to lead to a drop in performance levels, according to research published on bmj.com today (12 May 2010).
The findings have implications for policymakers, patients and clinicians, concluded the researchers, led by Helen Lester, Professor of Primary Care at Manchester University.
Eight QOF indicators are due to be removed in 2011. While existing research indicates that financial incentives lead to improvements in quality, few data exist on the effect of their removal.
The research evaluated the effect of financial incentives in 35 Kaiser Permanente facilities in California, which provided both general and speciality care.
They examined quality indicators for diabetes retinopathy screening, cervical cancer screening, glycaemic control for diabetes, and hypertension control.
During the study period – 1997 to 2007 – financial incentives were removed for diabetic retinopathy screening and cervical screening. Over the five years where financial incentives were attached to it, retinopathy screening rates rose from 84.9% to 88.1%. Over the following four years, without incentives, they fell year on year to 80.5%.
Rates of cervical screening rose slightly over the two initial years when financial incentives were attached, and fell during the five years when they were removed. Incentives were then reattached for two years, and rates began to climb once more.
The researchers point to limitations in the study, for example at Kaiser Permanente, doctors’ income is not affected by the incentive, unlike the UK.
However, if further research confirms that the removal of financial incentives means performance levels – and potentially patient care – decline, there may be practical implications for policymakers, clinicians, and patients, they conclude.