1. What do you consider to be the key issues for quality improvements in the NHS quality-improvement program as it goes forward? 2. What do you consider to be the strengths and weaknesses of the effort to improve the development of QOF indicators over the next couple of years? 3. The program appears to be using QALY metrics to justify the choices of future quality and outcome indicators. What are the strengths and weaknesses of such an approach to valuing quality? 4. Some researchers have expressed doubts about the improvement effectiveness of indicators in the high 90% range. What is your evaluation of this concern and what alternatives do recommend? 5. Most U.S. P4P efforts do not allow for exclusion of a significant number patients. What the pro and cons of this approach and the one used by NHS? 6. NHS is a single payer system. How does this affect its design of the QOF system and its efforts to implement it? How do the much more complex U.S. payment systems affect its utilization of the P4P systems? 7. The NHS QOF effort is obviously full of very specific point systems for evaluation. What are the strengths and weaknesses of such quantification of decision rules in a healthcare environment? Running Header: Continuing Improvement for the National Service Quality and Outcome Framework 1 Continuing Improvements for the National Health Service Quality and Outcomes Framework Michele Kratter Keiser University Professor Denton HSM 691/Quality Management in HealthcareQQ 2/13/2015 Management Healthcareuyanagement Healthcare Running Header: Continuing Improvements for the National Service Quality and Outcome Framework 2 1. What do you consider to be the key issues for quality improvements in the NHS quality-improvement program as it goes forward? The main theme of the NHS quality improvement program is to collect and review the data, in order to recognize the opportunities to improve business operations in healthcare. To bring changes in quality, it is necessary to respond to people's ideas and implement them for the better results. The key issues that are to be considered for quality-improvement NHS program, as it moves forward are, the needs for the clients, necessity of the funds for quality improvements, needs of the service providers and expectations of the community. 2. What do you consider to be the strengths and weaknesses of the effort to improve the development of QOF indicators over the next couple of years? The QOF indicators are designed to give incentive to the best practice for the care of people with long term conditions; compliance generates significant extra income for practices. Running Header: Continuing Improvements for the National Service Quality and Outcome Framework 3 However, it is unpopular due to bureaucracy involved in reporting and validating the data, so I believe they would need to improve this is the next few years and continue to simplify and eliminate the number of indicators, so the system becomes more reliable. 3. The program appears to be using QALY metrics to justify the choices of future quality and outcome indicators. What are the strengths and weaknesses of such an approach to valuing quality? Some of the strengths of QALY metrics are in valuing quality are helping to reduce the burden of the diseases of patients, increase the quality to the people. Some of the weaknesses are that it lacks sensitivity, it doesn't clearly measure the impact of the disease, impact on the family, it is difficult to apply to chronic diseases and life expectancy figures and facts might be vague. 4. Some researchers have expressed doubts about the improvement effectiveness of indicators in the high 90% range. What is your evaluation of this concern and what alternatives do recommend? Running Header: Continuing Improvements for the National Service Quality and Outcome Framework 4 Some of the values of the clinical values were determined by the NHS computerized system and were not based on the best adequate sampling data available. I would have kept the data of each clinical condition to a minimum number that would be compatible with patient care, or some kind of useful balanced data. There is a misrepresentation of a presence of a registry, since it is measured on the amount of time scheduled per visit. These visits were determined annually by patients, who visit each site or by variables determined by surveys. Johnson, J. McLaughlin, C. Sollecito, W. (2012). Implementing Continuous Quality Improvement 5. Most U.S. P4P efforts do not allow for exclusion of a significant number patients. What the pro and cons of this approach and the one used by NHS? The NHS approach to P4P allows for certain exclusions in the U.K., as it changes the nature of the office visit. Both programs involve paying physicians based on performance against targets, but the number of targets is much greater in the U.K. Pay-forperformance programs could have unintended effects on other aspects of care, especially on physician motivations. These effects include encourage physicians to avoid sicker patients, Running Header: Continuing Improvements for the National Service Quality and Outcome Framework 5 Exacerbating disparities, and neglecting certain types of care for which quality is not measured. Retrieved From: http://www.annfammed.org/content/7/2/121.long 6. NHS is a single payer system. How does this affect its design of the QOF system and its efforts to implement it? How do the much more complex U.S. payment systems affect its utilization of the P4P systems? The QOF systems of NHS single payer system has many difficulties in the effort for implementation due to empirical evidence showing that nationalized health care systems have undesirable consequence. There is insufficient funding over the program and there is constant pressures to contain spending and only indirect and infrequent pressures to increase it. The extensive implicit rationing is "severe and intentionally conceals life and death decisions from patients." (Ibid). Other problems to implement it are politically driven inequalities, personnel shortages, outdated facilities and medical equipment, waiting times, significant variation in patient care, financial waste, and loss of personal liberty. Running Header: Continuing Improvements for the National Service Quality and Outcome Framework 6 The U.S system being more complex has its own difficulties in its implementation of the P4P systems including clinical effectiveness, access and equity, coordination and continuity, patientcenteredness and cost-effectiveness. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936378/ 7. The NHS QOF effort is obviously full of very specific point systems for evaluation. What are the strengths and weaknesses of such quantification of decision rules in a healthcare environment? The NHS QOF point systems are not very consistent. This is because there is a greater association between the outcomes and deprivation than with any of the QOF scores. The relationship between socio-economic deprivation and health was much stronger. Despite some limitations, these results highlight the point that the clinical value of the QOF is dependent on the selection of the indicators. The process does not seem to have generated as sensitive a set of indicators as intended. The main limitation weakness is the short lag time between the implementation of the Running Header: Continuing Improvements for the National Service Quality and Outcome Framework 7 QOF and measurement of the health outcomes, which may not be efficient to assess the full impact of the QOF. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117011/