Effectiveness of quality incentive payments in general practice (EQuIP-GP): a study protocol for a cluster-randomised trial of an outcomes-based funding model in Australian general practice to improve patient care

Gregory M Peterson, Grant Russell, Jan C Radford, Nick Zwar, Danielle Mazza, Simon Eckermann, Judy Mullan, Marijka J Batterham, Athena Hammond, Andrew Bonney

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Abstract

BACKGROUND: There is international interest in whether improved primary care, in particular for patients with chronic or complex conditions, can lead to decreased use of health resources and whether financial incentives help achieve this goal. This trial (EQuIP-GP) will investigate whether a funding model based upon targeted, continuous quality incentive payments for Australian general practices increases relational continuity of care, and lessens health-service utilisation, for high-risk patients and children.

METHODS: We will use a mixed methods approach incorporating a two-arm pragmatic cluster randomised control trial with nested qualitative case studies. We aim to recruit 36 general practices from Practice-Based Research Networks (PBRN) covering urban and regional areas of Australia, randomised into intervention and control groups. Control practices will provide usual care while intervention practices will be supported to implement a new service model incorporating incentives for relational continuity and timely access to appointments. Patients will comprise three groups: older (over 65 years); 18-65 years with chronic and/or complex conditions; and those aged less than 16 years with increased risk of hospitalisation. The funding model includes financial incentives to general practitioners (GPs) for providing longer consultations, same day access and timely follow-up after hospitalisation to enrolled patients. The payments are proportional to expected health system savings associated with improved quality of GP care. An outreach facilitator will work with practices to help incorporate the incentive model into usual work. The main outcome measure is relational continuity of care (Primary Care Assessment Tool short-form survey), with secondary outcomes including health-related quality of life and health service use (hospitalisations, emergency presentations, GP and specialist services in the community, medicine prescriptions and targeted pathology and imaging ordering). Outcomes will be initially evaluated over a period of 12 months, with ongoing data collection for 5 years.

DISCUSSION: The trial will provide robust evidence on a novel approach to providing continuous incentives for improving quality of general practice care, which can be compared to block payment incentives awarded at target quality levels of pay-for-performance, both within Australia and also internationally.

TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000105246. Registered on 23 January 2018.

Original languageEnglish
Article number529
Number of pages14
JournalBMC Health Services Research
Volume19
Issue number1
DOIs
Publication statusPublished - 29 Jul 2019

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General Practice
Motivation
Patient Care
General Practitioners
Hospitalization
Continuity of Patient Care
Health Services
Primary Health Care
Incentive Reimbursement
Community Medicine
Health Resources
New Zealand
Prescriptions
Registries
Appointments and Schedules
Emergencies
Referral and Consultation
Quality of Life
Outcome Assessment (Health Care)
Clinical Trials

Cite this

Peterson, Gregory M ; Russell, Grant ; Radford, Jan C ; Zwar, Nick ; Mazza, Danielle ; Eckermann, Simon ; Mullan, Judy ; Batterham, Marijka J ; Hammond, Athena ; Bonney, Andrew. / Effectiveness of quality incentive payments in general practice (EQuIP-GP) : a study protocol for a cluster-randomised trial of an outcomes-based funding model in Australian general practice to improve patient care. In: BMC Health Services Research. 2019 ; Vol. 19, No. 1.
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Effectiveness of quality incentive payments in general practice (EQuIP-GP) : a study protocol for a cluster-randomised trial of an outcomes-based funding model in Australian general practice to improve patient care. / Peterson, Gregory M; Russell, Grant; Radford, Jan C; Zwar, Nick; Mazza, Danielle; Eckermann, Simon; Mullan, Judy; Batterham, Marijka J; Hammond, Athena; Bonney, Andrew.

In: BMC Health Services Research, Vol. 19, No. 1, 529, 29.07.2019.

Research output: Contribution to journalArticleResearchpeer-review

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T2 - a study protocol for a cluster-randomised trial of an outcomes-based funding model in Australian general practice to improve patient care

AU - Peterson, Gregory M

AU - Russell, Grant

AU - Radford, Jan C

AU - Zwar, Nick

AU - Mazza, Danielle

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AU - Batterham, Marijka J

AU - Hammond, Athena

AU - Bonney, Andrew

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AB - BACKGROUND: There is international interest in whether improved primary care, in particular for patients with chronic or complex conditions, can lead to decreased use of health resources and whether financial incentives help achieve this goal. This trial (EQuIP-GP) will investigate whether a funding model based upon targeted, continuous quality incentive payments for Australian general practices increases relational continuity of care, and lessens health-service utilisation, for high-risk patients and children.METHODS: We will use a mixed methods approach incorporating a two-arm pragmatic cluster randomised control trial with nested qualitative case studies. We aim to recruit 36 general practices from Practice-Based Research Networks (PBRN) covering urban and regional areas of Australia, randomised into intervention and control groups. Control practices will provide usual care while intervention practices will be supported to implement a new service model incorporating incentives for relational continuity and timely access to appointments. Patients will comprise three groups: older (over 65 years); 18-65 years with chronic and/or complex conditions; and those aged less than 16 years with increased risk of hospitalisation. The funding model includes financial incentives to general practitioners (GPs) for providing longer consultations, same day access and timely follow-up after hospitalisation to enrolled patients. The payments are proportional to expected health system savings associated with improved quality of GP care. An outreach facilitator will work with practices to help incorporate the incentive model into usual work. The main outcome measure is relational continuity of care (Primary Care Assessment Tool short-form survey), with secondary outcomes including health-related quality of life and health service use (hospitalisations, emergency presentations, GP and specialist services in the community, medicine prescriptions and targeted pathology and imaging ordering). Outcomes will be initially evaluated over a period of 12 months, with ongoing data collection for 5 years.DISCUSSION: The trial will provide robust evidence on a novel approach to providing continuous incentives for improving quality of general practice care, which can be compared to block payment incentives awarded at target quality levels of pay-for-performance, both within Australia and also internationally.TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618000105246. Registered on 23 January 2018.

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