News / Researchers show short-term impact of incentives on quality

A research paper published in the New England Journal of Medicine looked at the Advancing Quality (AQ) programme in North West England two years after it was introduced. It studied its impact on 1.8 million emergency admissions for heart attack, heart failure and pneumonia. Death rates within 30 days at 24 North West hospitals were compared with 137 hospitals across England.

Earlier research found 890 fewer deaths in the first 18 months. The latest study said quality of care continued to improve, but there was no further reduction in mortality compared with the rest of England.

University of Manchester researcher Søren Rud Kristensen, who led the new study, said: ‘These results suggest that the benefits of initiatives such as paying for performance may be temporary. Our findings could also be explained by the decision taken midway through the programme to change the incentives from bonuses for good performance to fines for failing to achieve targets.’

AQ said there could be a range of explanations, including a positive knock-on effect. The study found evidence of improved care of
North West patients outside the incentive scheme and in other regions.

AQ programme director Lesley Kitchen (left) added: ‘The AQ approach of strong clinical engagement and the auditing of compliance against a bundle of care processes is greatly improving reliability and delivering excellent care for more patients.’