Zhou Shijie, Lee Douglas S, Nguyen Francis, Benipal Harsukh, Perez Richard, Austin Peter C, Abdel-Qadir Husam, Udell Jacob A, Demers Catherine
Division of Cardiology, University of Toronto, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
CJC Open. 2025 May 12;7(8):1007-1013. doi: 10.1016/j.cjco.2025.05.002. eCollection 2025 Aug.
To support family physicians (FPs) in managing patients with heart failure (HF), the Ministry of Health in Ontario, Canada implemented the Q050A billing code in 2008, a pay-for-performance incentive for guideline-based HF care. We studied whether the incentive was associated with any change in the prescription of HF medications.
We identified all patients with HF in Ontario aged ≥ 66 years who were managed by FPs claiming the Q050A incentive between 2008 and 2021. We determined the proportion of patients who were prescribed renin-angiotensin system inhibitors (RASis), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and diuretics 3 months before and after the Q050A billing code was used in claims for these patients. As applicable, we classified the agents by whether they are guideline-directed as recommended by the Canadian Cardiovascular Society.
We included 39,425 HF patients in the study. The median age was 80 years (interquartile range, 73-85); 49% were female. Compared to the pre-Q050A period, prescriptions increased after the incentive was implemented, from 45.2% to 45.8% for RASis, 51.9% to 54.4% for BBs, 9.2% to 11.7% for MRAs, and 63.2% to 65.7% for diuretics ( < 0.05). The proportion of those who were not on any HF medications decreased from 27.5% to 24.9% ( < 0.001). Those with newly diagnosed HF and prompt follow-up with FPs experienced the largest-but a clinically modest-increase in HF medications.
The Q050A incentive led to a minimal increase in the prescription of HF medications; disease-modifying agents are underutilized.
为了支持家庭医生管理心力衰竭（HF）患者，加拿大安大略省卫生部于2008年实施了Q050A计费代码，这是一种基于指南的HF护理绩效付费激励措施。我们研究了该激励措施是否与HF药物处方的任何变化相关。
我们确定了安大略省所有年龄≥66岁、由申领Q050A激励措施的家庭医生管理的HF患者。我们确定了在这些患者的索赔中使用Q050A计费代码之前和之后3个月内，接受肾素 - 血管紧张素系统抑制剂（RASis）、β受体阻滞剂（BBs）、盐皮质激素受体拮抗剂（MRAs）和利尿剂治疗的患者比例。在适用的情况下，我们根据加拿大心血管学会的建议将这些药物按是否为指南指导用药进行分类。
我们纳入了39425例HF患者进行研究。中位年龄为80岁（四分位间距，73 - 85岁）；49%为女性。与Q050A实施前相比，激励措施实施后处方增加，RASis从45.2%增至45.8%，BBs从51.9%增至54.4%，MRAs从9.2%增至11.7%，利尿剂从63.2%增至65.7%（P<0.05）。未服用任何HF药物的患者比例从27.5%降至24.9%（P<0.001）。新诊断为HF且及时接受家庭医生随访的患者，HF药物的增加幅度最大，但在临床上增幅较小。
Q050A激励措施导致HF药物处方量略有增加；改善病情的药物未得到充分利用。
