Published 20 November 2008, doi:10.1136/bmj.a2097
Cite this as: BMJ 2008;337:a2097

Analysis

Fairness of financial penalties to improve control of Clostridium difficile

A Sarah Walker, statistician1,2, David Spiegelhalter, professor of the public understanding of risk3,4, Derrick W Crook, consultant microbiologist1, David Wyllie, research fellow5, James Morris, consultant pathologist1, Tim E A Peto, professor of infectious diseases1

1 National Institute for Health Research Oxford Biomedical Research Centre Programme, John Radcliffe Hospital, Oxford OX3 9DU, 2 MRC Clinical Trials Unit, London NW1 2DA, 3 MRC Biostatistics Unit, Institute of Public Health, Cambridge CB2 0SR, 4 Statistical Laboratory, Centre for Mathematical Sciences, Cambridge CB3 0WB, 5 Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, OX3 9DU

Correspondence to: A S Walker asw@ctu.mrc.ac.uk

Trusts in England have been given targets to reduce C difficile infection rates. But Sarah Walker and colleagues argue that the way they are calculated makes financial penalties almost impossible to avoid

The first 150 words of the full text of this article appear below.

Financial incentives are increasingly being used to promote delivery of efficient, high quality health care.1 2 3 However, it is widely agreed that such incentives have to be carefully constructed, with clear and simple links between behaviours or outcomes and incentives, direct indicators that validly measure the desired behaviours or outcomes, and sufficient stability to give surety to hospitals that effort (time, money) put into achieving targets is warranted.1 3 We examine how well these criteria are met by the financial penalties introduced for failing to reduce hospital acquired Clostridium difficile infection as part of the 2008-9 standard National Health Service contract for acute services.

In response to a new hypervirulent strain of C difficile causing large hospital outbreaks since 2003,4 5 the Department of Health recently set a target of a 30% reduction in C difficile infections in patients aged 2 years or older across the entire health economy (within and outside acute . . . [Full text of this article]


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