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Quality & safety in the literature: March 2019
  1. Ashwin Gupta1,2,
  2. Mark S Hausman, Jr.3,4,
  3. Nathan Houchens1,2
  1. 1 Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  2. 2 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  3. 3 Office of the Chief of Staff, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  4. 4 Department of Anesthesia, University of Michigan Medical School, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Ashwin Gupta, Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA; ashwing{at}med.umich.edu

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Healthcare quality and safety spans multiple topics across the spectrum of academic and clinical disciplines. Keeping abreast of the rapidly growing body of work can be challenging. In this series, we provide succinct summaries of selected relevant studies published in the last 6 months. Some articles will focus on a particular theme, while others will highlight unique publications from high impact medical journals.

Key points

  • Removal of financial quality-of-care incentives was associated with an immediate and persistent decline in documented quality indicators in comparison to those in which financial incentives remained. NEJM. 6 September 2018.

  • Hospital-at-home care bundled with a 30-day postacute transitional care programme resulted in a statistically significant reduction in length of stay, decreased odds of readmission, emergency department visit, and admission to skilled nursing facility, and increased patient satisfaction scores without increased adverse events. JAMA IM. 1 August 2018.

  • A structured, remote telehealth intervention for patients with heart failure, combined with usual care, reduced cardiovascular-related hospital admissions and all-cause mortality when compared with usual care alone. Lancet. 22 September 2018.

Quality of Care in the United Kingdom after Removal of Financial Incentives

New England Journal of Medicine 6 September 2018

In 2004, the UK implemented the Quality and Outcomes Framework (QOF), which at the time was the largest pay-for-performance healthcare reimbursement system in the world. In 2014, financial incentives were removed for 40 of the 121 quality of care indicators as part of a regular QOF review. However, performance data on many of these indicators continued to be collected. Minchin and colleagues1 designed an interrupted time-series analysis of electronic medical record data from 2010 to 2017. They compared 12 quality-of-care metrics for which financial incentives were removed with 6 metrics for which incentives had been maintained. These metrics included clinical process indicators (eg, smoking status documented in all adults, diabetes retinopathy screening documented), intermediate outcome indicators (eg, …

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Footnotes

  • Contributors All authors contributed equally to the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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