Langdown Carwyn, Peckham Stephen
Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
Centre for Health Services Studies, University of Kent, George Allen Wing, Canterbury, Kent CT2 7NF, UK Policy Research Unit in Commissioning and the Healthcare System, University of Manchester and CHSS, UK.
J Public Health (Oxf). 2014 Jun;36(2):251-8. doi: 10.1093/pubmed/fdt077. Epub 2013 Aug 8.
The quality and outcomes framework (QOF) is one of the world's largest pay-for-performance schemes, rewarding general practitioners for the quality of care they provide. This review examines the evidence on the efficacy of the scheme for improving health outcomes, its impact on non-incentivized activities and the robustness of the clinical targets adopted in the scheme.
The review was conducted using six electronic databases, six sources of grey literature and bibliography searches from relevant publications. Studies were identified using a comprehensive search strategy based on MeSH terms and keyword searches. A total of 21,543 references were identified of which 32 met the eligibility criteria with 11 studies selected for the review.
Findings provide strong evidence that the QOF initially improved health outcomes for a limited number of conditions but subsequently fell to the pre-existing trend. There was limited impact on non-incentivized activities with adverse effects for some sub-population groups.
The QOF has limited impact on improving health outcomes due to its focus on process-based indicators and the indicators' ceiling thresholds. Further research is required to strengthen the quality of evidence available on the QOF's impact on population health to ensure that the incentive scheme is both clinically and cost-effective.
质量与结果框架（QOF）是全球最大的绩效薪酬计划之一，根据全科医生提供的医疗服务质量给予奖励。本综述考察了该计划在改善健康结果方面的有效性证据、其对非激励性活动的影响以及该计划所采用临床指标的稳健性。
本综述使用六个电子数据库、六个灰色文献来源以及对相关出版物的参考文献检索进行。通过基于医学主题词（MeSH）和关键词检索的综合检索策略来识别研究。共识别出21543条参考文献，其中32条符合纳入标准，11项研究被选入综述。
研究结果提供了有力证据，表明QOF最初在有限数量的疾病方面改善了健康结果，但随后又回到了之前的趋势。对非激励性活动的影响有限，对一些亚人群体产生了不利影响。
由于QOF关注基于过程的指标以及指标的上限阈值，其对改善健康结果的影响有限。需要进一步研究以加强现有关于QOF对人群健康影响的证据质量，以确保激励计划在临床和成本效益方面都具有优势。
