Peterson, GM and Russell, G and Radford, J and Zwar, N and Mazza, D and Eckermann, S and Mullan, J and Batterham, MJ and Hammond, A and Bonney, A, Effectiveness of quality incentive payments in general practice (EQuIP-GP): a study protocol for a cluster-randomised trial of an outcomes-based funding model in Australian general practice to improve patient care, BMC Health Services Research, 19 Article 529. ISSN 1472-6963 (2019) [Refereed Article]
Copyright 2019 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/
Background: There is international interest in whether improved primary care, in particular for patients with chronic or complex conditions, can lead to decreased use of health resources and whether financial incentives help achieve this goal. This trial (EQuIP-GP) will investigate whether a funding model based upon targeted, continuous quality incentive payments for Australian general practices increases relational continuity of care, and lessens health-service utilisation, for high-risk patients and children.
Methods: We will use a mixed methods approach incorporating a two-arm pragmatic cluster randomised control trial with nested qualitative case studies. We aim to recruit 36 general practices from Practice-Based Research Networks (PBRN) covering urban and regional areas of Australia, randomised into intervention and control groups. Control practices will provide usual care while intervention practices will be supported to implement a new service model incorporating incentives for relational continuity and timely access to appointments. Patients will comprise three groups: older (over 65 years); 18–65 years with chronic and/or complex conditions; and those aged less than 16 years with increased risk of hospitalisation. The funding model includes financial incentives to general practitioners (GPs) for providing longer consultations, same day access and timely follow-up after hospitalisation to enrolled patients. The payments are proportional to expected health system savings associated with improved quality of GP care. An outreach facilitator will work with practices to help incorporate the incentive model into usual work. The main outcome measure is relational continuity of care (Primary Care Assessment Tool short-form survey), with secondary outcomes including health-related quality of life and health service use (hospitalisations, emergency presentations, GP and specialist services in the community, medicine prescriptions and targeted pathology and imaging ordering). Outcomes will be initially evaluated over a period of 12 months, with ongoing data collection for 5 years.
Discussion: The trial will provide robust evidence on a novel approach to providing continuous incentives for improving quality of general practice care, which can be compared to block payment incentives awarded at target quality levels of pay-for-performance, both within Australia and also internationally.
|Item Type:||Refereed Article|
|Keywords:||general practice, primary care, quality, continuity of care, funding, incentivisation, health services utilisation|
|Research Division:||Medical and Health Sciences|
|Research Group:||Public Health and Health Services|
|Research Field:||Primary Health Care|
|Objective Group:||Health and Support Services|
|Objective Field:||Evaluation of Health Outcomes|
|UTAS Author:||Peterson, GM (Professor Gregory Peterson)|
|UTAS Author:||Radford, J (Associate Professor Jan Radford)|
|Web of Science® Times Cited:||1|
|Downloads:||4 View Download Statistics|
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