Health Policy Report
Linking Physicians' Pay to the Quality of Care — A Major Experiment in the United Kingdom
N Engl J Med 2004; 351:1448-1454September 30, 2004DOI: 10.1056/NEJMhpr041294
- Article
Family practitioners are the main primary care physicians in the United Kingdom, making up half of the medical workforce in the National Health Service (NHS). In April of this year, family practitioners entered into a contract with the government that will provide additional payments for high-quality care in excess of £1 billion ($1.8 billion) — more than 20 percent of the previous family practice budget. One American commentator described this as “an initiative to improve the quality of primary care that is the boldest such proposal attempted anywhere in the world” and suggested that “with one mighty leap, the NHS has vaulted over anything being attempted in the United States, the previous leader in quality improvement initiatives.”1
Having been an adviser to the negotiating process, I describe here the development of this scheme to improve quality. I give an overview of the incentives offered and discuss some of the likely consequences, both intended and unintended, that may follow from this radical experiment.
The Professional Context
British family practitioners derive the great majority of their income from NHS patients. Almost all of the citizens of the United Kingdom are registered with a family practitioner, and family practitioners have registered lists of patients for whom they are responsible. Their work within the NHS is governed by a national contract, known as the General Medical Services contract, that is negotiated between professional representatives of the British Medical Association and the central government. This contract is revised at infrequent intervals; since the NHS was started in 1948, major contract revisions have been made only in 1966 and 1990.
Under the 2004 contract, responsibility moves from the individual family practitioner to the practice, which is a group of, typically, one to six physicians. However, this does not change the arrangement wherein the physician or practice is responsible for a defined group of patients. A substantial minority of family practitioners provide care under a different arrangement, known as the Personal Medical Services contract, but the principle of responsibility for a registered list of patients is the same. The application of the incentives to improve quality is also very similar in both types of practices, so no distinction has been drawn between them for the purposes of this article.
A previous attempt to provide financial incentives for high-quality care, dubbed a Good Practice Allowance, in the mid-1980s was rejected by the profession. A report from a meeting of the British Medical Association in 1986 stated that “the conference said `No' to a Good Practice Allowance. . . . Dr. [Michael] Wilson told the conference that the [Good Practice Allowance] was political and provocative, prepared by a policy unit whose main contact seemed to have been with philosophers, privateers and trendy professors.”2 At the time, there was little professional acceptance of the contention that wide variations existed in the practice of medicine, or that such variation might be detrimental to patient care.
Nevertheless, there were some elements of performance-linked pay in the contract that was introduced in 1990, with financial incentives for physicians who reached high proportions of patients who had been immunized or monitored with regular Papanicolaou smears. Although they were unpopular with the profession at the time, these two measures resulted in both increased coverage of immunization and Papanicolaou tests and increased equity in the provision of these services in different parts of the country.3,4 A second incentive that was introduced in the 1990 contract provided generous remuneration for family practitioners to establish “health promotion clinics” to encourage preventive screening and lifestyle interventions. There was little evidence that these clinics were effective, and they were widely manipulated by physicians for their own interests, which led to the elimination of payments for the clinics in the mid-1990s. Prior to the negotiation of the most recent contract, therefore, government and the profession had only limited experience with performance-related pay.
The Academic Context
Part of the reason that doctors rejected the Good Practice Allowance in the mid-1980s was that they rejected the notion that quality could be measured. In addition, there was a substantial degree of professional protectionism that took the form of denying the existence of poor practice. The 1990s were the years of evidence-based medicine, when health professionals gradually came to accept that there were better and worse ways of doing things and that there were justifiable limits to individual freedom in the clinical setting. This was also the decade when researchers in health care on both sides of the Atlantic demonstrated that there were widespread variations in the practice of medicine and that many patients were receiving care that fell short of what could be provided.5,6
The combined effect of these developments was that it became increasingly possible both to define high-quality care and to provide methods that could be used to measure some aspects of the quality of care.7 The change in the culture of the profession that occurred during this decade was enormous, and it stemmed in large part from research in the health services that was carried out in the United States and the United Kingdom.
The Political Context
With a change in the professional culture, and with the tools becoming available to measure the quality of care, the last piece of the jigsaw puzzle was the political will to bring in the proposed changes. To tie a substantial proportion of physicians' income to the quality of the care they provided would produce winners and losers. However, the British Medical Association was unlikely to negotiate a change in remuneration that would result in the loss of income for large numbers of its members. Therefore, the scale of the change that came about was possible only because in 2000 the government of the United Kingdom decided to provide a substantial increase in health care funding. This change came as a result of growing public disquiet over the quality of public services, a recognition of the serious underfunding of health care in the United Kingdom as compared with that of similar countries, and the publication of data suggesting poor outcomes for health care in the country. Wider factors such as a period of sustained economic growth also provided essential background to the government's ability to invest substantially in health care.
The Negotiating Process
The pieces of the jigsaw puzzle were then in place. There were demonstrable deficiencies in care that had been accepted by the profession. Professional representatives were willing to negotiate the provision of care that met higher standards in return for increased resources, and the government was willing to commit additional resources if there was evidence of improved performance. The contract negotiations involved a wide range of other issues, some of which will also produce major changes in primary care in the United Kingdom. These changes include the removal of the requirement that family practitioners provide care outside of normal office hours and the provision of additional payments for certain types of “enhanced” service (e.g., the treatment of drug abuse). However, only the changes that relate to the quality-of-care framework are described in this article.
Negotiations took place, over an 18-month period, between the British Medical Association (which acted as the doctors' representative) and the NHS Confederation (the organization that represented NHS management, which acted on behalf of the government) and with the assistance of a small group of academic advisers. The academic advisers drew on published national guidelines for sources of evidence, such as those from specialist societies or from the National Institute of Clinical Excellence (www.nice.nhs.uk). The advisers did not, in general, take into account the evidence from individual research papers if that evidence did not form part of such national guidance. The academic input was always advisory, and decisions were ultimately made by the negotiators. Only rarely were there serious differences between the parties, even though reaching a consensus sometimes required protracted discussion. The resulting indicators form the Quality and Outcomes Framework.
The Quality and Outcomes Framework
Family practitioners can now earn up to 1000 “points” for achievement in relation to the complex set of indicators that make up the Quality and Outcomes Framework. An additional 50 points are available for the provision of prompt access to services. Within the framework, there are three main sections: clinical care, practice organization, and patient experience.8 The points translate into pounds sterling (£), which are claimed on an annual basis. The process of earning points involves a complex formula that takes into account both the size of the practice and the prevalence at each practice of the conditions covered by the framework.
Clinical Indicators
The clinical indicators, measures of the quality of clinical care, pertain to specific aspects of care such as regularity of monitoring. They relate to 10 chronic conditions (Table 1Table 1
Clinical Indicators and Assigned Points in the Quality and Outcomes Framework.) that were chosen because of their prevalence or their importance in terms of the burden of disease. Table 2Table 2
Examples of Clinical Indicators and Assigned Points for Patients with Ischemic Heart Disease. shows examples of four indicators that relate to the management of blood pressure and cholesterol in patients with ischemic heart disease. Family practitioners earn more points if higher proportions of these patients have undergone “process measures” (i.e., they have had their blood pressure or cholesterol measured) and further points for “intermediate outcomes” (i.e., these risk factors have been managed within certain limits). Generally, more points are available for the intermediate outcomes than for the process measures, which reflects the increased difficulty of achieving these standards. The number of points that can be earned for each indicator was determined partly by the academic advisory group and partly by a formal scoring process undertaken by groups of family practitioners in England and Scotland. The intention behind this process was to allocate points on the basis of the workload required to provide care to the relevant standard. There will be a process within the NHS, which is not yet defined, to ensure that the indicators are periodically updated.In order to prevent care from being given to patients for whom it might not be appropriate, family practitioners may exclude patients from both the numerator and denominator of any individual indicator if the patients meet one of the following criteria for exclusion: they do not attend an office visit despite three written reminders, they have newly diagnosed conditions or are newly registered, they decline the intervention or treatment, they have not tolerated a medication that is specified in the contract, they are already receiving maximal doses of a medication (e.g., for the control of cholesterol) whose effects have been suboptimal, they have a condition (e.g., an allergy or a terminal illness) for which the intervention is not clinically appropriate, or they have a supervening condition that makes treatment inappropriate.
There is no limit on the number of patients whom family practitioners may exclude, although the physicians' decisions may be questioned at annual inspection visits by Primary Care Trusts, which are NHS organizations with managerial responsibility for primary care in geographic areas that contain up to 100 practices. Detailed guidance on the evidence that supports the use of these indicators, and on their application, is available at www.nhsconfed.org/docs/quality_and_outcomes_framework_guidance.pdf.
The intention of the negotiators was to produce a set of indicators based on the best available information, to keep the number of indicators to a minimum that would be compatible with an accurate assessment of patient care, and to base the indicators on information collected in the course of routine patient care and on data obtainable from the clinical computer systems of family practitioners.9 These were overly optimistic goals. The information requirements for the quality incentives will produce major changes in the recording of data in primary care, including the widespread computerization of clinical records, and substantial increases in the administrative burden on family practitioners.
The comprehensiveness of the indicators varies among the selected conditions. For diabetes and heart disease, for example, the indicators provide relatively comprehensive coverage of the most important clinical areas of care. In other areas, especially those relating to mental health and cancer, the indicators represent only partial coverage of the clinical areas — although in the case of cancer, both Papanicolaou tests and mammography are covered elsewhere in the family practitioner contract. However, more generally, quality indicators for these conditions (e.g., for mental health care10) may exist, but they are not necessarily in a form suitable for routine application to medical records. In order to make partial allowance for this deficit, audits of the care for both mental health and cancer are specifically rewarded under the organizational section of the framework (Table 3Table 3
Categories of Organizational Indicators and Assigned Points.).The data required to justify payments could, in theory, be collected from manual records. However, the intention is that they be extracted automatically from the computers of family practitioners. New clinical codes for the indicators in the framework have been standardized and agreed to with the suppliers of the main clinical computing systems in the United Kingdom. According to the strategic director of PRIMIS (www.primis.nhs.uk), family practitioners in the United Kingdom are already advanced in their use of information technology, with more than 90 percent of such physicians using computers for prescribing and between a third and half of them using computerized records for most of their clinical care. The incentives offered in the quality framework are likely to result in rapid further developments in the use of clinical computing systems. This will present a substantial challenge to some practices.
Organizational Indicators
Organizational indicators were included in five categories: records and information about patients, communication with patients, education and training, management of medicines, and management of physicians' practices. These organizational indicators were in part derived from indicators in a range of awards to practices given by the Royal College of General Practitioners; examples include the Quality Practice Award11 and Fellowship by Assessment.12 The categories of the organizational indicators, with one example from each, are shown in Table 3.
The Experience of Patients
The rewards in the section that covers the experience of patients relate to the use of surveys in the doctor's own practice, which earns up to 70 points, and to the length of consultations, which earns up to 30 points. For the latter, there is an incentive for practices whose routine booking interval is 10 minutes or more.
The introduction of patient surveys was a point of contention. Until recently, surveys have not been commonly used in the NHS, and doctors were suspicious of their use. Partly because of this, and partly because of limited experience with available instruments for evaluating patients' opinions, an early decision was made to reward doctors for surveying their patients and for acting on the results; however, payments would not be linked to the scores from actual questionnaires. Family practitioners may choose from one of two approved questionnaires, which cover categories such as access to and interpersonal aspects of care.13,14 Other questionnaires may be approved in due course. In addition to making plans for acting on survey results, there is an additional incentive for family practitioners to involve their patients in these discussions. The aim of this section of the framework, therefore, is to engage family practitioners in the process of discussing the evaluations of their patients, rather than to focus on the questionnaire scores. Nevertheless, experience thus far suggests that many Primary Care Trusts are offering to carry out these surveys for practices precisely so that they can draw comparisons among their local practices.
Financial Rewards
There are an additional 36 points for Papanicolaou tests, childhood immunizations, maternity services, and contraceptive services and 50 points for the achievement of high standards of access. An additional 130 points can be awarded to practices that score highly in all areas. In all, 1050 points are available, and, beginning in 2005, each point will be worth approximately £120 to the average practice in the United Kingdom (which has about 5500 patients and three practitioners). That is a potential increase in gross earnings of £42,000 (about $77,000) per physician. The quality-of-care payments are expected to make up approximately 20 percent of the government's total family practice budget, about 90 percent of which will be new payments.15 These figures are gross numbers and therefore include the additional costs (e.g., for the employment of nurses) that physicians may need to incur in order to deliver high standards of care. The percentage increase for individual physicians will thus depend on the extent to which they have already invested in high-quality systems in their practices.
Implementation and Inspection
The details of the new contract were voted on by family practitioners in June 2003. There was a 70 percent turnout, and 79 percent voted in favor. The contract came into operation last April, with some elements of its introduction postponed until April 2005. The negotiators who developed the Quality and Outcomes Framework were mindful of the need to minimize the risk of manipulation or gaming (e.g., recording a patient's blood pressure as being lower than it actually is). Although this may occur in some areas, practices that claim payments under the quality framework will be subject to inspection, which will include an annual visit by representatives of the Primary Care Trust. Among the inspectors will be local family practitioners who hold managerial positions in the Primary Care Trust. The penalties for making fraudulent claims are severe, but it is not known how comprehensive or effective the inspections will be.
Within a few years, virtually all of the data for the clinical indicators will be downloaded automatically from the computer systems of family practitioners. However, some of the opportunities for gaming, such as the example given above, will be very hard to detect. The negotiating teams hoped that, despite some gaming, there would nevertheless be widespread improvements in quality of care and that, over time, it would become harder for family practitioners to manipulate the system for their own interests than simply to provide good care.
The central collection of claims data will allow the government to monitor overall implementation of the quality framework, and mechanisms will be established to update the indicators when required. There is no coordinated national program of evaluation, but a number of academic departments are engaged in research in this area.
Consequences of the Contract
Financial incentives are an effective way of changing professional behavior,16,17 especially when the incentives are aligned with professional values and focused on areas that are agreed to be of clinical importance.18 They are being used increasingly in the United States as well as in other countries.19 With the size of the financial incentives being offered, there is no doubt that family practitioners in the United Kingdom will respond to them.
Some of the consequences that are likely to result from the introduction of the new contract — both the intended, positive, consequences and the unintended, potentially negative, ones — are outlined in Table 4Table 4
Anticipated Consequences of the New Incentives.. The clinical benefits of the contract may be relatively easy to quantify, with, for example, substantial probable benefits in terms of preventing cardiovascular events.20 Some of the negative effects will be much harder to assess. Increased specialization within practices may increase the quality of the management of disease, but the associated fragmentation of care could have negative consequences, especially for patients with multiple illnesses, who increasingly represent the rule rather than the exception.21 There is a more insidious possibility that professional motivation may be damaged by the focus on financial reward that is tied to specific tasks, and physicians may become less flexible in what they are prepared to do for patients.Some key attributes of care by the family practitioner, such as acting as an advocate for the patient, are not reflected anywhere in the contract. There is already some evidence that, when they focus on biomedical aspects of care, family practitioners may be less concerned about the patient as a person18 and that the whole discourse of primary care is becoming more oriented toward a biomedical model.22 Although the improvements in health from better clinical care can be estimated, the potential problems are much harder to quantify. Marshall and Smith have suggested that there may be a “halo effect,” with improved practice systems resulting in improved care in all clinical areas.23 However, others have argued that the disadvantages of the contract will outweigh the potential health gains and that there is a fundamental conflict between population-based public health objectives and the individual focus of patient care.24
There is also the possibility that the contract will lead to an increase in inequalities in the delivery of health care, with physicians preferentially locating to areas of the country where patients are healthier and better educated and where the targets are easier to achieve. Although this remains a possibility, the NHS has a number of mechanisms to encourage physicians to practice in disadvantaged areas, and the limited financial incentives in the previous contract for family practitioners led to a reduction, not an increase, in inequality of health care delivery in the targeted clinical areas.3,4
There is interest in using financial incentives to improve care in many countries. In Crossing the Quality Chasm, the U.S. Institute of Medicine has called for an increase in payments to providers of high-quality care.25 This reflects, in part, frustration with the modest changes in behavior that are seen with traditional educational approaches to the improvement of quality and, in part, the genuinely increased costs of providing high-quality care in certain areas (e.g., the employment of nurses to provide regular review clinics for patients with chronic disease). Many countries will look with interest at the research being conducted on the new contract in the United Kingdom to see which of its anticipated benefits and harmful effects will be realized.
Dr. Roland served as an academic adviser to the negotiating teams during the development of the Quality and Outcomes Framework and is currently engaged in research to evaluate the impact of the new contract.
Source Information
From the National Primary Care Research and Development Centre, University of Manchester, Manchester, United Kingdom.
- References
References
1
Shekelle P . New contract for general practitioners. BMJ 2003;326:457-458
CrossRef | Web of Science | Medline2
Report on the 1986 Conference of Local Medical Committees. BMJ 1986;293:1384-1386
CrossRef3
Baker D ,Middleton E . Cervical screening and health inequality in England in the 1990s. J Epidemiol Community Health 2003;57:417-423
CrossRef | Web of Science | Medline4
Middleton E ,Baker D . Comparison of social distribution of immunisation with measles, mumps, and rubella vaccine, England, 1991-2001. BMJ 2003;326:854-854
CrossRef | Web of Science | Medline5
Schuster MA ,McGlynn EA ,Brook RH . How good is the quality of health care in the United States? Milbank Q 1998;76:517-563
CrossRef | Web of Science | Medline6
Seddon ME ,Marshall MN ,Campbell SM ,Roland MO . Systematic review of studies of quality of clinical care in general practice in the UK, Australia and New Zealand. Qual Health Care 2001;10:152-158
CrossRef | Medline7
Brook RH ,McGlynn EA ,Cleary P . Quality of health care. Part 2: measuring quality of care. N Engl J Med 1996;335:966-970
Full Text | Web of Science | Medline8
Annex A: quality indicators — a summary of points. (Accessed September 10, 2004, at http://www.nhsconfed.org/docs/annex_a_quality_indicators.doc.)
9
Investing in general practice — the new General Medical Services contract. Paragraph 3.7. (Accessed September 10, 2004, at http://www.nhsconfed.org/docs/contract.pdf.)
10
Shield T ,Campbell S ,Rogers A ,Worrall A ,Chew-Graham C ,Gask L . Quality indicators for primary care mental health services. Qual Saf Health Care 2003;12:100-106
CrossRef | Web of Science | Medline11
Royal College of General Practitioners. Quality practice award (QPA). (Accessed September 10, 2004, at http://www.rcgp.org.uk/faculties/scotcoun/qpa.asp.)
12
Fellowship by assessment. (Accessed September 10, 2004, at http://www.rcgp.org.uk/external/fba/index.asp.)
13
General Practice Assessment Questionnaire (GPAQ). (Accessed September 10, 2004, at http://www.gpaq.info.)
14
Improving Practice Questionnaire (IPQ). (Accessed September 10, 2004, at http://www.exeter.ac.uk/Projects/cfep/ipq.htm.)
15
New GMS contract funding streams. (Accessed September 10, 2004, at http://www.bma.org.uk/ap.nsf/content/fundingstreams.)
16
Robinson JC . Theory and practice in the design of physician payment incentives. Milbank Q 2001;79:149-177
CrossRef | Web of Science | Medline17
Chaix-Couturier C ,Durand-Zaleski I ,Jolly D ,Durieux P . Effects of financial incentives on medical practice: results from a systematic review of the literature and methodological issues. Int J Qual Health Care 2000;12:133-142
CrossRef | Web of Science | Medline18
Spooner A ,Chapple A ,Roland M . What makes British general practitioners take part in a quality improvement scheme? J Health Serv Res Policy 2001;6:145-150
CrossRef | Medline19
Epstein AM ,Lee TH ,Hamel MB . Paying physicians for high-quality care. N Engl J Med 2004;350:406-410
Full Text | Web of Science | Medline20
McElduff P ,Lyratzopoulos G ,Edwards R ,Heller RF ,Shekelle P ,Roland M . Will changes in primary care improve health outcomes? Modelling the impact of financial incentives introduced to improve quality of care in the UK. Qual Saf Health Care 2004;13:191-197
CrossRef | Web of Science | Medline21
Starfield B ,Lemke KW ,Bernhardt T ,Foldes SS ,Forrest CB ,Weiner JP . Comorbidity: implications for the importance of primary care in `case' management. Ann Fam Med 2003;1:8-14
CrossRef | Medline22
Charles-Jones H ,Latimer J ,May C . Transforming general practice: the redistribution of medical work in primary care. Sociol Health Illn 2003;25:71-92
CrossRef | Web of Science | Medline23
Marshall M ,Smith P . Rewarding results: using financial incentives to improve quality. Qual Saf Health Care 2003;12:397-398
CrossRef | Web of Science | Medline24
Heath I . The new contract -- worth voting for? Br J Gen Pract 2002;52:602-602
Web of Science25
Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academy Press, 2001.
- Citing Articles (134)
Citing Articles
1
Tim Shortus, Lynn Kemp, Suzanne McKenzie, Mark Harris. (2013) ‘Managing patient involvement’: provider perspectives on diabetes decision-making. Health Expectations 16:2, 189-198
2
Malene Plejdrup Hansen, Lars Bjerrum, Bente Gahrn-Hansen, Rene de-Pont Christensen, Jesper Rømhild Davidsen, Anders Munck, Dorte Ejg Jarbol. (2013) Quality indicators for treatment of respiratory tract infections? An assessment by Danish general practitioners. European Journal of General Practice 19:2, 85-91
3
Ruth McDonald, Sudeh Cheraghi-Sohi, Sara Bayes, Richard Morriss, Joe Kai. (2013) Competing and coexisting logics in the changing field of English general medical practice. Social Science & Medicine
4
Charlotte A. M. Paddison, Gary A. Abel, Martin O. Roland, Marc N. Elliott, Georgios Lyratzopoulos, John L. Campbell. (2013) Drivers of overall satisfaction with primary care: evidence from the English General Practice Patient Survey. Health Expectationsn/a-n/a
5
Ilona S. Lorincz, Brittany C. T. Lawson, Judith A. Long. (2013) Provider and Patient Directed Financial Incentives to Improve Care and Outcomes for Patients with Diabetes. Current Diabetes Reports 13:2, 188-195
6
Tim Doran, Evangelos Kontopantelis. (2013) Pay-for-Performance: Impact on Diabetes. Current Diabetes Reports 13:2, 196-204
7
L. Hilts, M. Howard, D. Price, C. Risdon, G. Agarwal, A. Childs. (2013) Helping primary care teams emerge through a quality improvement program. Family Practice 30:2, 204-211
8
Frank Eijkenaar. (2013) Key issues in the design of pay for performance programs. The European Journal of Health Economics 14:1, 117-131
9
Robbie Foy, Louise Locock, Sarah Purdy, Catherine O'Donnell, Nicola Gray, Tim Doran, Huw Davies. (2013) Research shapes policy: but the dynamics are subtle. Public Money & Management 33:1, 9-14
10
Arna L. van Doorn-Klomberg, Jozé C.C. Braspenning, Remco C.W. Feskens, Margriet Bouma, Stephen M. Campbell, David Reeves. (2013) Precision of Individual and Composite Performance Scores. Medical Care 51:1, 115-121
11
Ermengol Coma, Manel Ferran, Leonardo Méndez, Begoña Iglesias, Francesc Fina, Manuel Medina. (2013) Creation of a synthetic indicator of quality of care as a clinical management standard in primary care. SpringerPlus 2:1, 51
12
Kirsten Kirschner, Jozé Braspenning, J. E. Annelies Jacobs, Richard Grol. (2013) Experiences of general practices with a participatory pay-for-performance program: a qualitative study in primary care. Australian Journal of Primary Health 19:2, 102
13
Diana Menya, John Logedi, Imran Manji, Janice Armstrong, Brian Neelon, Wendy Prudhomme O¿Meara. (2013) An innovative pay-for-performance (P4P) strategy for improving malaria management in rural Kenya: protocol for a cluster randomized controlled trial. Implementation Science 8:1, 48
14
Menno van Woerkom, Hans Piepenbrink, Brian Godman, Joost de Metz, Stephen Campbell, Marion Bennie, Marietta Eimers, Lars L Gustafsson. (2012) Ongoing measures to enhance the efficiency of prescribing of proton pump inhibitors and statins in The Netherlands: influence and future implications. Journal of Comparative Effectiveness Research 1:6, 527-538
15
Richard Cookson, Mauro Laudicella, Paolo Li Donni. (2012) Measuring change in health care equity using small-area administrative data – Evidence from the English NHS 2001–2008. Social Science & Medicine 75:8, 1514-1522
16
Lora A. Reineck, Jeremy M. Kahn. (2012) Pay-for-Performance in Pulmonary Medicine. Clinical Pulmonary Medicine 19:5, 206-214
17
Evangelos Kontopantelis, Tim Doran, Hugh Gravelle, Rosalind Goudie, Luigi Siciliani, Matt Sutton. (2012) Family Doctor Responses to Changes in Incentives for Influenza Immunization under the U.K. Quality and Outcomes Framework Pay-for-Performance Scheme. Health Services Research 47:3pt1, 1117-1136
18
C. Ll. Morgan, S. Jenkins-Jones, M. Evans, A. H. Barnett, C. D. Poole, C. J. Currie. (2012) Weight change in people with type 2 diabetes: secular trends and the impact of alternative antihyperglycaemic drugs. Diabetes, Obesity and Metabolism 14:5, 424-432
19
K. W. Wong, S. Y. Ho, D. V. K. Chao. (2012) Quality of diabetes care in public primary care clinics in Hong Kong. Family Practice 29:2, 196-202
20
Andrew M. Ryan, Tim Doran. (2012) The Effect of Improving Processes of Care on Patient Outcomes. Medical Care 50:3, 191-199
21
P.-C. Chen, Y.-C. Lee, R. N. Kuo. (2012) Differences in patient reports on the quality of care in a diabetes pay-for-performance program between 1 year enrolled and newly enrolled patients. International Journal for Quality in Health Care
22
Mohammed Abuelkhair, Shajahan Abdu, Brian Godman, Sahar Fahmy, Rickard E Malmström, Lars L Gustafsson. (2012) Imperative to consider multiple initiatives to maximize prescribing efficiency from generic availability: case history from Abu Dhabi. Expert Review of Pharmacoeconomics & Outcomes Research 12:1, 115-124
23
H. Gilbert, B. Leurent, S. Sutton, R. Morris, C. Alexis-Garsee, I. Nazareth. (2012) Factors predicting recruitment to a UK wide primary care smoking cessation study (the ESCAPE trial). Family Practice 29:1, 110-117
24
M Kowalkowski, J B Gould, C Bose, L A Petersen, J Profit. (2012) Do practicing clinicians agree with expert ratings of neonatal intensive care unit quality measures?. Journal of Perinatology
25
W.J. Elliott. (2012) Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study. Yearbook of Cardiology 2012, 40-43
26
Kirsten Kirschner, Joze Braspenning, JE Annelies Jacobs, Richard Grol. (2012) Design choices made by target users for a pay-for-performance program in primary care: an action research approach. BMC Family Practice 13:1, 25
27
Damian G. Fogarty, Maarten W. Taal. A Stepped Care Approach to the Management of Chronic Kidney Disease. In: Brenner and Rector's The Kidney. Elsevier, 2012:2205-2239.
28
Hilde Luijks, Tjard Schermer, Hans Bor, Chris van Weel, Toine Lagro-Janssen, Marion Biermans, Wim de Grauw. (2012) Prevalence and incidence density rates of chronic comorbidity in type 2 diabetes patients: an exploratory cohort study. BMC Medicine 10:1, 128
29
Kerin Hannon, Sarah Peters, Louise Fisher, Lisa Riste, Alison Wearden, Karina Lovell, Pam Turner, Yvonne Leech, Carolyn Chew-Graham. (2012) Developing resources to support the diagnosis and management of Chronic Fatigue Syndrome/Myalgic Encephalitis (CFS/ME) in primary care: a qualitative study. BMC Family Practice 13:1, 93
30
M.a de los Santos Ichaso Hernández-Rubio, Sandra García Armesto. (2011) Indicadores en atención primaria: la realidad o el deseo. Informe SESPAS 2012. Gaceta Sanitaria
31
D. Petek, B. Kunzi, J. Kersnik, J. Szecsenyi, M. Wensing. (2011) Patients' evaluations of European general practice--revisited after 11 years. International Journal for Quality in Health Care 23:6, 621-628
32
R. Lowrie, F. S. Mair, N. Greenlaw, P. Forsyth, P. S. Jhund, A. McConnachie, B. Rae, J. J. V. McMurray, . (2011) Pharmacist intervention in primary care to improve outcomes in patients with left ventricular systolic dysfunction. European Heart Journal
33
Karen J. Hoare, Jane Mills, Karen Francis. (2011) The role of Government policy in supporting nurse-led care in general practice in the United Kingdom, New Zealand and Australia: an adapted realist review. Journal of Advanced Nursingno-no
34
P. Bower, W. Macdonald, E. Harkness, L. Gask, T. Kendrick, J. M. Valderas, C. Dickens, T. Blakeman, B. Sibbald. (2011) Multimorbidity, service organization and clinical decision making in primary care: a qualitative study. Family Practice 28:5, 579-587
35
Mark Dusheiko, Hugh Gravelle, Stephen Martin, Nigel Rice, Peter C. Smith. (2011) Does better disease management in primary care reduce hospital costs? Evidence from English primary care. Journal of Health Economics 30:5, 919-932
36
Eva Thors Adolfsson, Andreas Rosenblad. (2011) Reporting systems, reporting rates and completeness of data reported from primary healthcare to a Swedish quality register – The National Diabetes Register. International Journal of Medical Informatics 80:9, 663-668
37
Gerd Flodgren, Elena Parmelli, Gaby Doumit, Melina Gattellari, Mary Ann O'Brien, Jeremy Grimshaw, Martin P Eccles, Martin P Eccles. Local opinion leaders: effects on professional practice and health care outcomes. In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2011.
38
Bryan Burford, Michael Greco, Ajay Bedi, Charlotte Kergon, Gill Morrow, Moira Livingston, Jan Illing. (2011) Does questionnaire-based patient feedback reflect the important qualities of clinical consultations? Context, benefits and risks. Patient Education and Counseling 84:2, e28-e36
39
Philip Prah, Irene Petersen, Irwin Nazareth, Kate Walters, David Osborn. (2011) National changes in oral antipsychotic treatment for people with schizophrenia in primary care between 1998 and 2007 in the United Kingdom. Pharmacoepidemiology and Drug Safetyn/a-n/a
40
Georgios Lyratzopoulos, Marc N. Elliott, Josephine M. Barbiere, Laura Staetsky, Charlotte A. Paddison, John Campbell, Martin Roland. (2011) How can Health Care Organizations be Reliably Compared?. Medical Care 49:8, 724-733
41
Luka Vončina, Tihomir Strizrep, Brian Godman, Marion Bennie, Iain Bishop, Stephen Campbell, Vera Vlahović-Palčevski, Lars L Gustafsson. (2011) Influence of demand-side measures to enhance renin–angiotensin prescribing efficiency in Europe: implications for the future. Expert Review of Pharmacoeconomics & Outcomes Research 11:4, 469-479
42
Hugh Gravelle, Arne Risa Hole, Rita Santos. (2011) Measuring and testing for gender discrimination in physician pay: English family doctors. Journal of Health Economics 30:4, 660-674
43
Tinh-Hai Collet, Sophie Salamin, Lukas Zimmerli, Eve A. Kerr, Carole Clair, Michel Picard-Kossovsky, Eric Vittinghoff, Edouard Battegay, Jean-Michel Gaspoz, Jacques Cornuz, Nicolas Rodondi. (2011) The Quality of Primary Care in a Country with Universal Health Care Coverage. Journal of General Internal Medicine 26:7, 724-730
44
Skye C. Mayo, Andrew D. Shore, Hari Nathan, Barish H. Edil, Kenzo Hirose, Robert A. Anders, Christopher L. Wolfgang, Richard D. Schulick, Michael A. Choti, Timothy M. Pawlik. (2011) Refining the definition of perioperative mortality following hepatectomy using death within 90 days as the standard criterion. HPB 13:7, 473-482
45
Martin Emmert, Frank Eijkenaar, Heike Kemter, Adelheid Susanne Esslinger, Oliver Schöffski. (2011) Economic evaluation of pay-for-performance in health care: a systematic review. The European Journal of Health Economics
46
A. R. H. Dalton, R. Alshamsan, A. Majeed, C. Millett. (2011) Exclusion of patients from quality measurement of diabetes care in the UK pay-for-performance programme. Diabetic Medicine 28:5, 525-531
47
Emmanuela Gakidou, Leslie Mallinger, Jesse Abbott-Klafter, Ramiro Guerrero, Salvador Villalpando, Ruy Lopez Ridaura, Wichai Aekplakorn, Mohsen Naghavi, Stephen Lim, Rafael Lozano, Christopher JL Murray. (2011) Management of diabetes and associated cardiovascular risk factors in seven countries: a comparison of data from national health examination surveys. Bulletin of the World Health Organization 89:3, 172-183
48
S. O’Kelly, S.M. Smith, S. Lane, C. Teljeur, T. O’Dowd. (2011) Chronic respiratory disease and multimorbidity: Prevalence and impact in a general practice setting. Respiratory Medicine 105:2, 236-242
49
M. Schrappe, N. Gültekin. (2011) Pay for Performance (P4P). Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 54:2, 166-170
50
Mark Dusheiko, Tim Doran, Hugh Gravelle, Catherine Fullwood, Martin Roland. (2011) Does Higher Quality of Diabetes Management in Family Practice Reduce Unplanned Hospital Admissions?. Health Services Research 46:1p1, 27-46
51
Oddvar Kaarboe, Luigi Siciliani. (2011) Multi-tasking, quality and pay for performance. Health Economics 20:2, 225-238
52
Martin P Eccles, Susan Hrisos, Jill J Francis, Elaine Stamp, Marie Johnston, Gillian Hawthorne, Nick Steen, Jeremy M Grimshaw, Marko Elovainio, Justin Presseau, Margaret Hunter. (2011) Instrument development, data collection, and characteristics of practices, staff, and measures in the Improving Quality of Care in Diabetes (iQuaD) Study. Implementation Science 6:1, 61
53
Robbie Foy, Martin P Eccles, Susan Hrisos, Gillian Hawthorne, Nick Steen, Ian Gibb, Bernard Croal, Jeremy Grimshaw. (2011) A cluster randomised trial of educational messages to improve the primary care of diabetes. Implementation Science 6:1, 129
54
Allison Worth, Hilary Pinnock, Monica Fletcher, Gaylor Hoskins, Mark L Levy, Aziz Sheikh. (2011) Systems for the management of respiratory disease in primary care – an international series: United Kingdom. Primary Care Respiratory Journal 20:1, 23
55
André M Toschke, Martin C Gulliford, Charles DA Wolfe, Anthony G Rudd, Peter U Heuschmann. (2011) Antihypertensive treatment after first stroke in primary care: results from the General Practitioner Research Database. Journal of Hypertension 29:1, 154-160
56
Debby G Keuken, Henk J Brouwer, Parad S Keijser, Raynold C Bruessing. (2011) Diabetes care: reasons for missing HbA1c measurements in general practice. BMC Research Notes 4:1, 234
57
Edward P. Havranek. Measuring Quality Outcomes in Heart Failure. In: Heart Failure: A Companion to Braunwald's Heart Disease. Elsevier, 2011:560-569.
58
G. M. Magee, S. J. Hunter, C. R. Cardwell, G. Savage, F. Kee, M. C. Murphy, D. G. Fogarty. (2010) Identifying additional patients with diabetic nephropathy using the UK primary care initiative. Diabetic Medicine 27:12, 1372-1378
59
Kate Lager, Amit K Mistri. (2010) Current status of blood pressure management after stroke. Expert Review of Cardiovascular Therapy 8:11, 1587-1598
60
Fran Tanner, Robbie Foy, Wendy Harrison. (2010) ‘Wads up, doc’ – trends in British newspapers’ reporting of general practitioners’ pay. Primary Health Care Research & Development 11:04, 405-409
61
Lisa I. Iezzoni. (2010) Multiple Chronic Conditions and Disabilities: Implications for Health Services Research and Data Demands. Health Services Research 45:5p2, 1523-1540
62
V. Owen, I. Seetho, I. Idris. (2010) Predictors of responders to insulin therapy at 1 year among adults with type 2 diabetes. Diabetes, Obesity and Metabolism 12:10, 865-870
63
Grace A. Lin, Rita F. Redberg, H. Vernon Anderson, Richard E. Shaw, Sarah Milford-Beland, Eric D. Peterson, Sunil V. Rao, Rachel M. Werner, R. Adams Dudley. (2010) Impact of Changes in Clinical Practice Guidelines on Assessment of Quality of Care. Medical Care 48:8, 733-738
64
J. Murray, S. Saxena, C. Millett, V. Curcin, S. de Lusignan, A. Majeed. (2010) Reductions in risk factors for secondary prevention of coronary heart disease by ethnic group in south-west London: 10-year longitudinal study (1998-2007). Family Practice 27:4, 430-438
65
Diane R. Rittenhouse, David H. Thom, Julie A. Schmittdiel. (2010) Developing a Policy-Relevant Research Agenda for the Patient-Centered Medical Home: A Focus on Outcomes. Journal of General Internal Medicine 25:6, 593-600
66
U. Chauhan, E. Kontopantelis, S. Campbell, H. Jarrett, H. Lester. (2010) Health checks in primary care for adults with intellectual disabilities: how extensive should they be?. Journal of Intellectual Disability Research 54:6, 479-486
67
Cynthia M. Boyd, Lisa Reider, Katherine Frey, Daniel Scharfstein, Bruce Leff, Jennifer Wolff, Carol Groves, Lya Karm, Stephen Wegener, Jill Marsteller, Chad Boult. (2010) The Effects of Guided Care on the Perceived Quality of Health Care for Multi-morbid Older Persons: 18-Month Outcomes from a Cluster-Randomized Controlled Trial. Journal of General Internal Medicine 25:3, 235-242
68
Hugh Gravelle, Matt Sutton, Ada Ma. (2010) Doctor Behaviour under a Pay for Performance Contract: Treating, Cheating and Case Finding?. The Economic Journal 120:542, F129-F156
69
S. de Lusignan, K. Khunti, J. Belsey, A. Hattersley, J. van Vlymen, H. Gallagher, C. Millett, N. J. Hague, C. Tomson, K. Harris, A. Majeed. (2010) A method of identifying and correcting miscoding, misclassification and misdiagnosis in diabetes: a pilot and validation study of routinely collected data. Diabetic Medicine 27:2, 203-209
70
Diane McGinn, Brian Godman, Julie Lonsdale, Rosalind Way, Björn Wettermark, Alan Haycox. (2010) Initiatives to enhance the quality and efficiency of statin and PPI prescribing in the UK: impact and implications. Expert Review of Pharmacoeconomics & Outcomes Research 10:1, 73-85
71
Katharina Janus. Managing motivation among health care professionals. Emerald Group Publishing, 2010:47-77.
72
Timothy Hoff. (2010) Managing the negatives of experience in physician teams. Health Care Management Review 35:1, 65-76
73
Richard G. Stefanacci. Managed Care for Older Americans. In: Brocklehurst's Textbook of Geriatric Medicine and Gerontology. Elsevier, 2010:1057-1063.
74
J. C Crosson, P. A Ohman-Strickland, S. Campbell, R. L Phillips, M. O Roland, E. Kontopantelis, A. Bazemore, B. Balasubramanian, B. F Crabtree. (2009) A comparison of chronic illness care quality in US and UK family medicine practices prior to pay-for-performance initiatives. Family Practice 26:6, 510-516
75
Michael Kuhn, Luigi Siciliani. (2009) Performance Indicators for Quality with Costly Falsification. Journal of Economics & Management Strategy 18:4, 1137-1154
76
Anthony Scott, Stefanie Schurer, Paul H. Jensen, Peter Sivey. (2009) The effects of an incentive program on quality of care in diabetes management. Health Economics 18:9, 1091-1108
77
C. Norman, R. Zarrinkoub, J. Hasselström, B. Godman, F. Granath, B. Wettermark. (2009) Potential savings without compromising the quality of care. International Journal of Clinical Practice 63:9, 1320-1326
78
Björn Wettermark, Brian Godman, Bengt Jacobsson, Flora M. Haaijer-Ruskamp. (2009) Soft regulations in pharmaceutical policy making. Applied Health Economics and Health Policy 7:3, 137-147
79
Campbell , Stephen M. , Reeves , David , Kontopantelis , Evangelos , Sibbald , Bonnie , Roland , Martin , . (2009) Effects of Pay for Performance on the Quality of Primary Care in England. New England Journal of Medicine 361:4, 368-378
Free Full Text80
Thomas Foels, Sharon Hewner. (2009) Integrating Pay for Performance with Educational Strategies to Improve Diabetes Care. Population Health Management 12:3, 121-129
81
Carmel M. Martin, Chris Peterson. (2009) The social construction of chronicity - a key to understanding chronic care transformations. Journal of Evaluation in Clinical Practice 15:3, 578-585
82
Ruth McDonald, Stephen Campbell, Helen Lester. (2009) Practice nurses and the effects of the new general practitioner contract in the English National Health Service: The extension of a professional project?. Social Science & Medicine 68:7, 1206-1212
83
Ruth McDonald, Kath Checkland, Stephen Harrison, Anna Coleman. (2009) Rethinking collegiality: Restratification in English general medical practice 2004–2008. Social Science & Medicine 68:7, 1199-1205
84
Loren Riskin, Jason A Campagna. (2009) Quality assessment by external bodies: intended and unintended impact on healthcare delivery. Current Opinion in Anaesthesiology 22:2, 237-241
85
Kristina Khanduja, Damon C. Scales, Neill K. J. Adhikari. (2009) Pay for performance in the intensive care unit—Opportunity or threat?*. Critical Care Medicine 37:3, 852-858
86
Matt Sutton, Ross Elder, Bruce Guthrie, Graham Watt. (2009) Record rewards: the effects of targeted quality incentives on the recording of risk factors by primary care providers. Health Economicsn/a-n/a
87
Christopher Millett, Jeremy Gray, Martin Wall, Azeem Majeed. (2009) Ethnic Disparities in Coronary Heart Disease Management and Pay for Performance in the UK. Journal of General Internal Medicine 24:1, 8-13
88
Ruth McDonald, Kath Checkland, Steve Harrison. (2009) The new GP contract in English primary health care: an ethnographic study. International Journal of Public Sector Management 22:1, 21-34
89
David Martin, James A. Wright. (2009) Disease prevalence in the English population: A comparison of primary care registers and prevalence models. Social Science & Medicine 68:2, 266-274
90
Jae Wook Jeong, Nak Jin Sung. (2009) Present Status of Papers on the Primary Care Quality Assessment in Korea. Korean Journal of Family Medicine 30:7, 525
91
Alexander A. Hannenberg, Daniel I. Sessler. (2008) Improving Perioperative Temperature Management. Anesthesia & Analgesia 107:5, 1454-1457
92
A. Viljoen. (2008) Cardiovascular risk estimation - making sense of the numbers. International Journal of Clinical Practice 62:9, 1300-1303
93
Raisa Deber, Marcus J. Hollander, Philip Jacobs. (2008) Models of funding and reimbursement in health care: A conceptual framework. Canadian Public Administration 51:3, 381-405
94
Doran , Tim , Fullwood , Catherine , Reeves , David , Gravelle , Hugh , Roland , Martin , . (2008) Exclusion of Patients from Pay-for-Performance Targets by English Physicians. New England Journal of Medicine 359:3, 274-284
Free Full Text95
Anne Fuhlbrigge, Vincent J. Carey, Jonathan A. Finkelstein, Paula Lozano, Thomas S. Inui, Kevin B. Weiss. (2008) Are Performance Measures Based on Automated Medical Records Valid for Physician/Practice Profiling of Asthma Care?. Medical Care 46:6, 620-626
96
Olaug S. Lian. (2008) Global challenges, global solutions? A cross-national comparison of primary health care in Britain, Norway and the Czech Republic. Health Sociology Review 17:1, 27-40
97
Caroline Ann Daly, Janina Stepinska, Tomasz Deptuch, Witold Ruzyllo, Kevin Fox, Anselm Gitt, Michal Tendera, Kim Fox. (2008) Differences in presentation and management of Stable Angina from East to West in Europe: A comparison between Poland and the UK. International Journal of Cardiology 125:3, 311-318
98
Stephen Buetow, Linda Bryant. (2008) Is the Rate of Generic Drug Prescribing a Fair Measure for Pay for Performance?. Disease Management & Health Outcomes 16:6, 377-380
99
Ruth Wintz, Brian Rosenthal, Stephen Z. Fadem. (2008) The Physician Quality Reporting Initiative: A Practical Approach to Implementing Quality Reporting. Advances in Chronic Kidney Disease 15:1, 56-63
100
Ruth McDonald, Stephen Harrison, Kath Checkland. (2008) Incentives and control in primary health care: findings from English pay-for-performance case studies. Journal of Health Organisation and Management 22:1, 48-62
101
Tim Doran. (2008) Lessons from Early Experience with Pay for Performance. Disease Management & Health Outcomes 16:2, 69-77
102
Stephen Buetow. (2008) Pay-for-performance in New Zealand primary health care. Journal of Health Organisation and Management 22:1, 36-47
103
Tim Doran, Catherine Fullwood. (2007) Pay for performance: Is it the best way to improve control of hypertension?. Current Hypertension Reports 9:5, 360-367
104
Norbert Donner-Banzhoff, Matthias Schrappe, Monika Lelgemann. (2007) Studien zur Versorgungsforschung. Eine Hilfe zur kritischen Rezeption. Zeitschrift für ärztliche Fortbildung und Qualität im Gesundheitswesen - German Journal for Quality in Health Care 101:7, 463-471
105
A. L. Schutz, M. A. Counte, S. Meurer. (2007) Assessment of patient safety research from an organizational ergonomics and structural perspective. Ergonomics 50:9, 1451-1484
106
Heidrun Sturm, Astrid Austvoll-Dahlgren, Morten Aaserud, Andrew D Oxman, Craig R Ramsay, Åsa Vernby, Jan Peter Kösters, Heidrun Sturm. Pharmaceutical policies: effects of financial incentives for prescribers. In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd, 2007.
107
Campbell , Stephen , Reeves , David , Kontopantelis , Evangelos , Middleton , Elizabeth , Sibbald , Bonnie , Roland , Martin , . (2007) Quality of Primary Care in England with the Introduction of Pay for Performance. New England Journal of Medicine 357:2, 181-190
Free Full Text108
David Reeves, Stephen M. Campbell, John Adams, Paul G. Shekelle, Evan Kontopantelis, Martin O. Roland. (2007) Combining Multiple Indicators of Clinical Quality. Medical Care 45:6, 489-496
109
Robert L Kane. (2007) Strategies for improving chronic illness care: some issues for the NHS. Aging Health 3:3, 333-342
110
M. C. Gulliford, M. Ashworth, D. Robotham, A. Mohiddin. (2007) Achievement of metabolic targets for diabetes by English primary care practices under a new system of incentives. Diabetic Medicine 24:5, 505-511
111
Tim Coleman, Sarah Lewis, Richard Hubbard, Christopher Smith. (2007) Impact of contractual financial incentives on the ascertainment and management of smoking in primary care. Addiction 102:5, 803-808
112
Laurent G. Glance, Turner M. Osler, Dana B. Mukamel, Andrew W. Dick. (2007) Use of a Matching Algorithm to Evaluate Hospital Coronary Artery Bypass Grafting Performance as an Alternative to Conventional Risk Adjustment. Medical Care 45:4, 292-299
113
Frederick I. Burge, Kelly Bower, Wayne Putnam, Jafna L. Cox. (2007) Quality indicators for cardiovascular primary care. Canadian Journal of Cardiology 23:5, 383-388
114
Fredrik Carlsen, Jostein Grytten, Julie Kjelvik, Irene Skau. (2007) Better primary physician services lead to fewer hospital admissions. The European Journal of Health Economics 8:1, 17-24
115
Judith Smith, Nicholas Mays. (2007) Primary care organizations in New Zealand and England: tipping the balance of the health system in favour of primary care?. The International Journal of Health Planning and Management 22:1, 3-19
116
Constance Liu, Brook Watts, David Litaker. (2006) Access to and utilization of healthcare: the provider’s role. Expert Review of Pharmacoeconomics & Outcomes Research 6:6, 653-660
117
Stephen Buetow, Peter Adams. (2006) Is There Any Ideal of ‘High Quality Care’ Opposing ‘Low Quality Care’? A Deconstructionist Reading. Health Care Analysis 14:2, 123-132
118
(2006) Pay-for-Performance Programs in the United Kingdom. New England Journal of Medicine 355:17, 1832-1833
Free Full Text119
Abdu Mohiddin, Smriti Naithani, Dan Robotham, Olubukola Ajakaiye, Dominic Costa, Steve Carey, Richard H. Jones, Martin C. Gulliford. (2006) Sharing specialist skills for diabetes in an inner city: A comparison of two primary care organisations over 4
years. Journal of Evaluation in Clinical Practice 12:5, 583-590
120
G I Varughese, J V Patel, G Y H Lip. (2006) Blood pressure control in the setting of diabetes mellitus: new targets, new hope for improvement?. Journal of Human Hypertension 20:9, 635-637
121
BRENDA LEESE, VICTORIA ALLGAR, PHIL HEYWOOD, REG WALKER, AAMRA DARR, IKHLAQ DIN, ROBERT M. WEST. (2006) A new role for nurses as Primary Care Cancer Lead Clinicians in Primary Care Trusts in England. Journal of Nursing Management 14:6, 462-471
122
Doran , Tim , Fullwood , Catherine , Gravelle , Hugh , Reeves , David , Kontopantelis , Evangelos , Hiroeh , Urara , Roland , Martin , . (2006) Pay-for-Performance Programs in Family Practices in the United Kingdom. New England Journal of Medicine 355:4, 375-384
Free Full Text123
Susan L. Ettner, Theodore J. Thompson, Mark R. Stevens, Carol M. Mangione, Catherine Kim, W. Neil Steers, Jennifer Goewey, Arleen F. Brown, Richard S. Chung, K. M. Venkat Narayan, . (2006) Are Physician Reimbursement Strategies Associated with Processes of Care and Patient Satisfaction for Patients with Diabetes in Managed Care?. Health Services Research 0:0, 060720074824048-???
124
Blumenthal , David , . (2006) Employer-Sponsored Health Insurance in the United States — Origins and Implications. New England Journal of Medicine 355:1, 82-88
Full Text125
David C. Miller, John T. Wei, James E. Montie, Brent K. Hollenbeck. (2006) Quality of care and performance-based reimbursement: The contemporary landscape and implications for urologists. Urology 67:6, 1117-1125
126
Noel J. Genova. (2006) Paying for performance. Journal of the American Academy of Physician Assistants 19:6, 25-26
127
Bruce L. Hall, Darrell A. Campbell, Laurel R.S. Phillips, Barton H. Hamilton. (2006) Evaluating Individual Surgeons Based on Total Hospital Costs: Evidence for Variation in both Total Costs and Volatility of Costs. Journal of the American College of Surgeons 202:4, 565-576
128
Jon B. Christianson, David J. Knutson, Roger S. Mazze. (2006) Physician Pay-For-Performance.. Journal of General Internal Medicine 21:S2, S9-S13
129
Marc Berg, Wim Schellekens. (2005) Kwaliteit kan niet zonder meten. Huisarts en Wetenschap 48:10, 306-308
130
Elias Mossialos, Adam Oliver. (2005) An overview of pharmaceutical policy in four countries: France, Germany, the Netherlands and the United Kingdom. The International Journal of Health Planning and Management 20:4, 291-306
131
Tom Walley, Monique Mrazek, Elias Mossialos. (2005) Regulating pharmaceutical markets: improving efficiency and controlling costs in the UK. The International Journal of Health Planning and Management 20:4, 375-398
132
Peter Lucassen. (2005) Kwaliteit is een dilemma. Huisarts en Wetenschap 48:10, 299-305
133
DAVID C. MILLER, JAMES E. MONTIE, JOHN T. WEI. (2005) MEASURING THE QUALITY OF CARE FOR LOCALIZED PROSTATE CANCER. The Journal of Urology 174:2, 425-431
134
Elias Mossialos, Tom Walley, Caroline Rudisill. (2005) Provider incentives and prescribing behavior in Europe. Expert Review of Pharmacoeconomics & Outcomes Research 5:1, 81-93
