Abstract:
PURPOSE:Primary care practices in the United Kingdom have received substantial financial rewards for achieving standards set out in the Quality and Outcomes Framework since April 2004. This article reviews the growing evidence for the impact of the framework on the quality of primary medical care. METHODS:Five hundred seventy-five articles were identified by searching the MEDLINE, EMBASE, and PsycINFO databases, and from the reference lists of published reviews and articles. One hundred twenty-four relevant articles were assessed using a modified Downs and Black rating scale for 110 observational studies and a Critical Appraisal Skills Programme rating scale for 14 qualitative studies. Ninety-four studies were included in the review. RESULTS:Quality of care for incentivized conditions during the first year of the framework improved at a faster rate than the preintervention trend and subsequently returned to prior rates of improvement. There were modest cost-effective reductions in mortality and hospital admissions in some domains. Differences in performance narrowed in deprived areas compared with nondeprived areas. Achievement for conditions outside the framework was lower initially and has worsened in relative terms since inception. Some doctors reported improved data recording and teamwork, and nurses enhanced specialist skills. Both groups believed that the person-centeredness of consultations and continuity were negatively affected. Patients' satisfaction with continuity declined, with little change in other domains of patient experience. CONCLUSIONS:Observed improvements in quality of care for chronic diseases in the framework were modest, and the impact on costs, professional behavior, and patient experience remains uncertain. Further research is needed into how to improve quality across different domains, while minimizing costs and any unintended adverse effects of payment for performance schemes. Health care organizations should remain cautious about the benefits of similar schemes.
journal_name
Ann Fam Medjournal_title
Annals of family medicineauthors
Gillam SJ,Siriwardena AN,Steel Ndoi
10.1370/afm.1377subject
Has Abstractpub_date
2012-09-01 00:00:00pages
461-8issue
5eissn
1544-1709issn
1544-1717pii
10/5/461journal_volume
10pub_type
杂志文章,评审abstract:PURPOSE:In a primary care context favoring group practices, we assessed the validity of 2 new continuity measures (both versions of known provider continuity, KPC) that capture the concentration of care over time from multiple physicians (multiple provider continuity, KPC-MP) or from the physician seen most often (pers...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1692
更新日期:2014-11-01 00:00:00
abstract:PURPOSE:Our goal was to monitor the progress of 3 Healthy People 2010 (HP2010) objectives encouraging self-management education and clinician counseling for weight loss and physical activity among adults with doctor-diagnosed arthritis. METHODS:Using the national 2002 and 2006 National Health Interview Survey (NHIS) a...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1210
更新日期:2011-03-01 00:00:00
abstract:PURPOSE:Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMHs), few PCMHs in Minnesota have incorporated these health workers into their care teams. We undertook...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究
doi:10.1370/afm.2171
更新日期:2018-01-01 00:00:00
abstract:PURPOSE:Students' idealism and desire to work with underserved populations decline as they progress from preclinical training through clerkships and residency. With an increasingly diverse population and increasing health disparities, academic health centers need to incorporate changes in their curricula to train socia...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.543
更新日期:2006-09-01 00:00:00
abstract:PURPOSE:A randomized controlled trial found that patients with diabetes had lower HbA1c levels after 6 months of peer health coaching than patients who did not receive coaching. This paper explores whether the peer coaches in that trial, all low-income patients with diabetes, mastered and utilized an evidence-based hea...
journal_title:Annals of family medicine
pub_type: 杂志文章,随机对照试验
doi:10.1370/afm.1756
更新日期:2015-08-01 00:00:00
abstract:PURPOSE:Postpartum depression (PPD) screening at 4 to 12 weeks' postpartum can improve outcomes for women when linked to in-practice management programs. The benefit of repeated PPD screening during the first year postpartum remains unclear. METHODS:We report a substudy of a large pragmatic trial of early PPD screenin...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1777
更新日期:2015-05-01 00:00:00
abstract:PURPOSE:Little is known about the impact of pay-for-performance incentives on health care disparities. We examined ethnic disparities in the management of hypertension among patients with and without cardiovascular comorbidities after the implementation of a major pay-for-performance incentive scheme in UK primary care...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.907
更新日期:2008-11-01 00:00:00
abstract:PURPOSE:Bacterial pathogens are assumed to cause an illness course different from that of nonbacterial causes of acute cough, but evidence is lacking. We evaluated the disease course of lower respiratory tract infection (LRTI) with a bacterial cause in adults with acute cough. METHODS:We conducted a secondary analysis...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1370/afm.1974
更新日期:2016-11-01 00:00:00
abstract:PURPOSE:Avoidable hospitalizations due to adverse drug events and high-risk prescribing are common in older people. Primary care physicians prescribe most on-going medicines. Deprescribing has long been essential to best prescribing practice. We sought to explore the views of primary care physicians on the barriers and...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2094
更新日期:2017-07-01 00:00:00
abstract:PURPOSE:Little is known regarding the effects of psychological factors on data collection in research studies. We examined whether Five Factor Model (FFM) personality factors-Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness-predicted missing data in a randomized controlled trial (RCT). METHODS...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.920
更新日期:2009-03-01 00:00:00
abstract::The American Board of Family Medicine routinely surveys its Diplomates in each national graduating cohort 3 years out of training. These data were used to characterize early career family physicians whose services include management of pregnancy and prescribing buprenorphine. A total of 261 (5.1%) respondents both pro...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2504
更新日期:2020-03-01 00:00:00
abstract:PURPOSE:We undertook a study to evaluate the effectiveness of corticosteroid injections in primary care patients with greater trochanteric pain syndrome (GTPS). METHODS:We evaluated the effect of corticosteroid injections compared with expectant treatment (usual care) in a pragmatic, multicenter, open-label, randomize...
journal_title:Annals of family medicine
pub_type: 杂志文章,随机对照试验
doi:10.1370/afm.1232
更新日期:2011-05-01 00:00:00
abstract:PURPOSE:In this study, we compared the rate of depression diagnoses in adults with and without diabetes mellitus, while carefully controlling for number of primary care visits. METHODS:We matched adults with incident diabetes (n = 2,932) or prevalent diabetes (n = 14,144) to nondiabetic control patients based on (1) a...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.964
更新日期:2009-07-01 00:00:00
abstract:PURPOSE:We wanted to obtain perspectives of mothers and daughters on facilitators of and barriers to with adolescent girls' timely access to risk-appropriate reproductive care. METHODS:We conducted 5 separate focus groups with Latina and black mothers and their adolescent daughters. All participants resided in impover...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究
doi:10.1370/afm.601
更新日期:2006-11-01 00:00:00
abstract:PURPOSE:Few studies have attempted to link patients' beliefs about racism in the health care system with how they use and experience health care. METHODS:Using telephone survey data from a national sample of 1,479 whites, 1,189 African Americans, and 983 Latinos, we explored patients' beliefs about racism, their prefe...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.282
更新日期:2005-03-01 00:00:00
abstract:PURPOSE:Few clinical guidelines focus on how physicians can identify intimate partner violence (IPV) perpetration or victimization among male patients, and little is known of men's experiences and beliefs regarding screening in health care settings. Our objective was to determine prevalence of men's experiences with IP...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2536
更新日期:2020-07-01 00:00:00
abstract::As a family physician, I have become increasingly uncomfortable being associated with the US health care system. While shiny, new buildings go up each day, there is still little movement toward a model that will shore up the crumbling foundation. The current delivery system and financing structures are unsustainable. ...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.837
更新日期:2008-05-01 00:00:00
abstract:PURPOSE:Conducting studies in national practice-based research networks presents logistic and methodologic challenges. Pediatric Research in Office Settings (PROS) has learned valuable lessons in implementing new strategies and adapting to challenges. We describe practical challenges and results of novel applied strate...
journal_title:Annals of family medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1370/afm.1809
更新日期:2015-09-01 00:00:00
abstract::The exposure to unethical and unprofessional behavior is thought to play a major role in the declining empathy experienced by medical students during their training. We reflect on the reasons why medical schools are tolerant of unethical behavior of faculty. First, there are barriers to reporting unprofessional behavi...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1763
更新日期:2015-03-01 00:00:00
abstract:PURPOSE:In screening for type 2 diabetes, guidelines recommend targeting high-risk individuals. Our objectives were to assess the yield of opportunistic targeted screening for type 2 diabetes in primary care and to assess the diagnostic value of various risk factors. METHODS:In 11 family practices (total practice popu...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.997
更新日期:2009-09-01 00:00:00
abstract:PURPOSE:Our goal was to describe an approach to patient-centered medical home (PCMH) measurement based on delineating the desired properties of the measurement relative to assumptions about the PCMH and the uses of the measure by Blue Cross Blue Shield of Michigan (BCBSM) and health services researchers. METHODS:We de...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1472
更新日期:2013-05-01 00:00:00
abstract:PURPOSE:Adolescent mothers are at risk for rapidly becoming pregnant again and for depression, school dropout, and poor parenting. We evaluated the impact of a community-based home-visiting program on these outcomes and on linking the adolescents with primary care. METHODS:Pregnant adolescents aged 12 to 18 years, pre...
journal_title:Annals of family medicine
pub_type: 杂志文章,随机对照试验
doi:10.1370/afm.629
更新日期:2007-05-01 00:00:00
abstract:PURPOSE:This study was conducted to document current immunization practices by family physicians. METHODS:In 2008 the American Academy of Family Physicians (AAFP) conducted a survey among a random sample of 2,000 of its members who reported spending 80% or more of their time in direct patient care. The survey consiste...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1185
更新日期:2010-11-01 00:00:00
abstract::We propose a new set of priorities for quality management in primary care, acknowledging that payers and regulators likely will continue to insist on reporting numerical quality metrics. Primary care practices have been described as complex adaptive systems. Traditional quality improvement processes applied to linear ...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2014
更新日期:2017-03-01 00:00:00
abstract:PURPOSE:Unexplained gastrointestinal symptoms are more common in adults who recall abuse as a child; however, data available on children are limited. The aim of this study was to investigate the association of childhood maltreatment and early development of gastrointestinal symptoms and whether this relation was mediat...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.1053
更新日期:2010-03-01 00:00:00
abstract:PURPOSE:The explosion of evidence in the last decade supporting the role of spirituality in whole-person patient care has prompted proposals for a move to a biopsychosocial-spiritual model for health. Making this paradigm shift in today's multicultural societies poses many challenges, however. This article presents 2 t...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.864
更新日期:2008-09-01 00:00:00
abstract:PURPOSE:Describe the duration of symptoms, proportion of parents seeking primary care consultations, and costs for respiratory tract infections (RTIs) of children in the community. METHODS:Community-based, online, prospective inception cohort study. General practitioners from socioeconomically diverse practices posted...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2327
更新日期:2019-01-01 00:00:00
abstract:PURPOSE:At this second anniversary of the Annals of Family Medicine, we sought to characterize primary care research and to identify opportunities for new directions by analyzing the content of the first and second volumes of the Annals. METHODS:Using an a priori classification scheme, 2 editors independently categori...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.330
更新日期:2005-05-01 00:00:00
abstract:PURPOSE:Studies among adults suggest that patient-provider racial concordance is associated with higher satisfaction and partnership with physicians. It remains unknown whether similar findings are true for children. This study examines the association of race/ethnicity concordance with parent reports of children's pri...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.27
更新日期:2003-07-01 00:00:00
abstract:PURPOSE:Self-harm is a public health problem that requires a better understanding of mortality risk. We undertook a study to examine premature mortality in a nationally representative cohort of primary care patients who had harmed themselves. METHODS:During 2001-2013, a total of 385 general practices in England contri...
journal_title:Annals of family medicine
pub_type: 杂志文章
doi:10.1370/afm.2054
更新日期:2017-05-01 00:00:00