Table 2 Summary of P4P model elements in selected countries

England

QOF

Clinical domain:

Atrial fibrillation, secondary to coronary heart disease, heart failure, hypertension, peripheral arterial disease, stroke and TIA, diabetes, asthma, chronic obstructive pulmonary disease, Alzheimer’s disease, mental health, cancer, chronic kidney disease, epilepsy, disabilities, osteoporosis, rheumatism, palliative care, civilian hyperglycemia.

• Public health domain

Blood pressure, obesity, smoking, vaccination and belief, cervical screening

• Quality improvement domain

Prescription Drug Dependency, Optimizing Access to General Practice

Each indicator has a point value. The value of one QOF point for 2021-22 is £194. 83..

Absolute

Per cent of target met after minimum threshold is reached

Electronic health record

New Zealand

PHO

Chronic disease screening

• Breast cancer coverage, cervical cancer screening coverage, ischemic heart disease diagnosis, heart disease risk assessment, diagnosis, post-diagnosis diagnosis, smoking status, Western advice or support to quit smoking

Per cent attainment of target

Absolute

Electronic health record

Prevention of infectious diseases

• Influenza vaccination in the elderly (over 65 years), percentage of children fully vaccinated.

Germany

DMP

• • Documentation and coordination

• Information, consultation, registration and preparation of initial documents, preparation of draft follow-up documents

• • Follow up of patients

• Continuity of care and treatment of patients with type 2 diabetes

• • Additional services

• Comprehensive consultation for diagnosis of diabetic neuropathy, care of diabetic foot lesions in each foot, referral to nephrologist, eye exam documentation

• • Training fee

• Treatment and educational program for patients without insulin therapy (four sessions with a maximum of four patients in four weeks), auxiliary materials for education (without diabetes license)., treatment and educational program for patients with high blood pressure.

Flat rate for participation and per service

Absolute

Claims data

France

ROSP

• Prevention and screening

Influenza immunization (2 indicators), breast cancer screening (1 indicator), cervical cancer screening (1 indicator), prescription of vasodilator drugs for elderly patients (1 indicator), prescription of long half-life benzodiazepines (2 indicators), antibiotics therapy ( 1 index)

• Chronic disease management

diabetes (8 indicators), blood pressure (1 indicator),

•Cost- effective prescribing

Antibiotics (1 index), PPIs (1 index), statins (1 index), antihypertensive drugs (1 index), antidepressants (1 index), ACEI/ARBs (1 index), aspirin (1 index)

Achievement rate- progress toward target relative to baseline performance

Absolute

Claims data

• Practice organization

Updating the electronic file system (1 indicator), approved prescription software (1 indicator), computer equipment and software for online consultation (1 indicator), notification through the clinic website (1 indicator), annual evaluation of medical records electronic patient, and providing a combined report to the patient (1 indicator)

Australia

PIP

Quality stream

Quality Prescribing, Diabetes Incentive, Cervical Screening Incentive, Asthma Incentive, Indigenous Health Incentive

Capacity stream

eHealth Incentive, Practice Nurse Incentive, After Hours Incentive, Teaching Incentive, Aged Care Access Incentive

Rural support stream

Rural Loading, Procedural GP Payment, Domestic Violence Incentive

Flat rate for participation, targets, and per patient reached

Absolute

Claims data

Canada

FHO

Cumulative preventive care

Influenza vaccination for people over 65 years old, children vaccination, cervical cancer screening (Pap smear), breast cancer screening (mammography), colorectal cancer screening)

• Additional service incentives

After-hours care, newborn care, congestive heart failure, smoking cessation counseling, maternity services, palliative care, home visits (other than palliative care), long-term care, Laboure and Delivery, Office Procedures, prenatal care, hospital services Special, primary health care for patients with serious mental illnesses

Per cent attainment of target

Absolute

Claims data

US – California

Integrated Healthcare Association (IHA) Program

Clinical Quality

1.Cardiovascular

2.Diabetes Care

3.Musculoskeletal

4.Prevention

5.Respiratory

Varies by insurer

Varies by insurer

Claims data

Meaningful Use of HIT

1. Use CPOE for medication orders.

2. Implement drug- drug and drug- allergy interaction checks

3. Maintain up- to- date problem list of current and active diagnoses

4. Generate and transmit permissible prescriptions electronically (eRx)

5. Maintain active medication list

6. Maintain active medication allergy list

7. Record demographics

8. Record and chart changes in vital signs

9. Record smoking status

10. Report ambulatory clinical quality measures

11. Implement one clinical decision support rule relevant to specialty or high clinical priority, along with the ability to track compliance with that rule

12. Provide patients with an electronic copy of their health information

13. Provide clinical summaries for patients at each office visit

14. Capability to exchange key clinical information

15. Protect electronic health information created or maintained by the certified EHR technology

16–20. Any (5) CMS/ONC Menu set measures

21. Chronic Care Management for Diabetes, Depression and one other Clinically Important Condition

22. Within- PO Performance Variation

Patient Experience

1. Doctor–Patient Interaction Composite for PCPs

2. Doctor–Patient Interaction Composite for Specialists

3. Coordination of Care Composite

4. Timely Care and Service Composite for PCPs

5. Timely Care and Service Composite for Specialists

6. Overall Ratings of Care Composite

7. Office Staff Composite

8. Health Promotion Composite

Appropriate Resource Use

1. Inpatient Utilization: Acute Care Discharges PTMY

2. Inpatient Utilization: Bed Days PTMY

3. Inpatient Readmission Within 30 days

4. Emergency Department Visits PTMY

5. Outpatient Procedures Utilization: per cent Done in Preferred Facility

6. Generic Prescribing: SSRIs/SNRIs

7. General Prescribing: Statins

8. Generic Prescribing: Anti- Ulcer agents

9. General Prescribing: Cardiac- Hypertension and Cardiovascular

10. Generic Prescribing: Nasal Steroids

11. General Prescribing: Diabetes – Oral

12. Generic Prescribing: Anxiety/Sedation – Sleep Aids

13. Total Cost of Care

14. Frequency of Selected Procedures – Back Surgery

15. Frequency of Selected Procedures – Total Hip Replacement

16. Frequency of Selected Procedures – Total Knee Replacement

17. Frequency of Selected Procedures – Bariatric Weight Loss Surgery

18. Frequency of Selected Procedures – PCI

19. Frequency of Selected Procedures – Carotid Catheterization

20. Frequency of Selected Procedures – CABG

21. Frequency of Selected Procedures – Cardiac Endarterectomy