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The equity dimension in evaluations of the quality and outcomes framework: a systematic review

Pauline Boeckxstaens UGent, Delphine De Smedt UGent, Jan De Maeseneer UGent, Lieven Annemans UGent and Sara Willems UGent (2011) BMC HEALTH SERVICES RESEARCH. 11.
abstract
Background: Pay-for-performance systems raise concerns regarding inequity in health care because providers might select patients for whom targets can easily be reached. This paper aims to describe the evolution of preexisting (in) equity in health care in the period after the introduction of the Quality and Outcomes Framework (QOF) in the UK and to describe (in) equities in exception reporting. In this evaluation, a theory-based framework conceptualising equity in terms of equal access, equal treatment and equal treatment outcomes for people in equal need is used to guide the work. Methods: A systematic MEDLINE and Econlit search identified 317 studies. Of these, 290 were excluded because they were not related to the evaluation of QOF, they lacked an equity dimension in the evaluation, their qualitative research focused on experiences or on the nature of the consultation, or unsuitable methodology was used to pronounce upon equity after the introduction of QOF. Results: None of the publications (n = 27) assessed equity in access to health care. Concerning equity in treatment and (intermediate) treatment outcomes, overall quality scores generally improved. For the majority of the observed indicators, all citizens benefit from this improvement, yet the extent to which different patient groups benefit tends to vary and to be highly dependent on the type and complexity of the indicator(s) under study, the observed patient group(s) and the characteristics of the study. In general, the introduction of QOF was favourable for the aged and for males. Total QOF scores did not seem to vary according to ethnicity. For deprivation, small but significant residual differences were observed after the introduction of QOF favouring less deprived groups. These differences are mainly due to differences at the practice level. The variance in exception reporting according to gender and socio-economic position is low. Conclusions: Although QOF seems not to be socially selective at first glance, this does not mean QOF does not contribute to the inverse care law. Introducing different targets for specific patient groups and including appropriate, non-disease specific and patient-centred indicators that grasp the complexity of primary care might refine the equity dimension of the evaluation of QOF. Also, information on the actual uptake of care, information at the patient level and monitoring of individuals' health care utilisation tracks could make large contributions to an in-depth evaluation. Finally, evaluating pay-for-quality initiatives in a broader health systems impact assessment strategy with equity as a full assessment criterion is of utmost importance.
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author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
CORONARY-HEART-DISEASE, PAY-FOR-PERFORMANCE, CROSS-SECTIONAL SURVEY, PRIMARY MEDICAL-CARE, GENERAL-PRACTITIONER QUALITY, SOCIAL DEPRIVATION, PRACTICE SIZE, HEALTH-CARE, DIABETES MANAGEMENT, OF-CARE
journal title
BMC HEALTH SERVICES RESEARCH
BMC Health Serv. Res.
volume
11
article number
209
pages
15 pages
Web of Science type
Article
Web of Science id
000295416400001
JCR category
HEALTH CARE SCIENCES & SERVICES
JCR impact factor
1.66 (2011)
JCR rank
37/75 (2011)
JCR quartile
2 (2011)
ISSN
1472-6963
DOI
10.1186/1472-6963-11-209
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
1945920
handle
http://hdl.handle.net/1854/LU-1945920
date created
2011-11-21 16:00:13
date last changed
2017-03-07 12:18:56
@article{1945920,
  abstract     = {Background: Pay-for-performance systems raise concerns regarding inequity in health care because providers might select patients for whom targets can easily be reached. This paper aims to describe the evolution of preexisting (in) equity in health care in the period after the introduction of the Quality and Outcomes Framework (QOF) in the UK and to describe (in) equities in exception reporting. In this evaluation, a theory-based framework conceptualising equity in terms of equal access, equal treatment and equal treatment outcomes for people in equal need is used to guide the work. 
Methods: A systematic MEDLINE and Econlit search identified 317 studies. Of these, 290 were excluded because they were not related to the evaluation of QOF, they lacked an equity dimension in the evaluation, their qualitative research focused on experiences or on the nature of the consultation, or unsuitable methodology was used to pronounce upon equity after the introduction of QOF. 
Results: None of the publications (n = 27) assessed equity in access to health care. Concerning equity in treatment and (intermediate) treatment outcomes, overall quality scores generally improved. For the majority of the observed indicators, all citizens benefit from this improvement, yet the extent to which different patient groups benefit tends to vary and to be highly dependent on the type and complexity of the indicator(s) under study, the observed patient group(s) and the characteristics of the study. In general, the introduction of QOF was favourable for the aged and for males. Total QOF scores did not seem to vary according to ethnicity. For deprivation, small but significant residual differences were observed after the introduction of QOF favouring less deprived groups. These differences are mainly due to differences at the practice level. The variance in exception reporting according to gender and socio-economic position is low. 
Conclusions: Although QOF seems not to be socially selective at first glance, this does not mean QOF does not contribute to the inverse care law. Introducing different targets for specific patient groups and including appropriate, non-disease specific and patient-centred indicators that grasp the complexity of primary care might refine the equity dimension of the evaluation of QOF. Also, information on the actual uptake of care, information at the patient level and monitoring of individuals' health care utilisation tracks could make large contributions to an in-depth evaluation. Finally, evaluating pay-for-quality initiatives in a broader health systems impact assessment strategy with equity as a full assessment criterion is of utmost importance.},
  articleno    = {209},
  author       = {Boeckxstaens, Pauline and De Smedt, Delphine and De Maeseneer, Jan and Annemans, Lieven and Willems, Sara},
  issn         = {1472-6963},
  journal      = {BMC HEALTH SERVICES RESEARCH},
  keyword      = {CORONARY-HEART-DISEASE,PAY-FOR-PERFORMANCE,CROSS-SECTIONAL SURVEY,PRIMARY MEDICAL-CARE,GENERAL-PRACTITIONER QUALITY,SOCIAL DEPRIVATION,PRACTICE SIZE,HEALTH-CARE,DIABETES MANAGEMENT,OF-CARE},
  language     = {eng},
  pages        = {15},
  title        = {The equity dimension in evaluations of the quality and outcomes framework: a systematic review},
  url          = {http://dx.doi.org/10.1186/1472-6963-11-209},
  volume       = {11},
  year         = {2011},
}

Chicago
Boeckxstaens, Pauline, Delphine De Smedt, Jan De Maeseneer, Lieven Annemans, and Sara Willems. 2011. “The Equity Dimension in Evaluations of the Quality and Outcomes Framework: a Systematic Review.” Bmc Health Services Research 11.
APA
Boeckxstaens, P., De Smedt, D., De Maeseneer, J., Annemans, L., & Willems, S. (2011). The equity dimension in evaluations of the quality and outcomes framework: a systematic review. BMC HEALTH SERVICES RESEARCH, 11.
Vancouver
1.
Boeckxstaens P, De Smedt D, De Maeseneer J, Annemans L, Willems S. The equity dimension in evaluations of the quality and outcomes framework: a systematic review. BMC HEALTH SERVICES RESEARCH. 2011;11.
MLA
Boeckxstaens, Pauline, Delphine De Smedt, Jan De Maeseneer, et al. “The Equity Dimension in Evaluations of the Quality and Outcomes Framework: a Systematic Review.” BMC HEALTH SERVICES RESEARCH 11 (2011): n. pag. Print.