Analysis

Challenges of incentivising patient centred care

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4532 (Published 06 October 2017) Cite this as: BMJ 2017;359:j4532
  1. Rachel Foskett-Tharby, honorary research fellow12,
  2. Nick Hex, associate director2,
  3. Antony Chuter, lay patient and public representative1,
  4. Paramjit Gill, professor of general practice3
  1. 1Institute for Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
  2. 2York Health Economics Consortium, University of York, York, UK
  3. 3Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
  1. Correspondence to: R Foskett-Tharby r.fosketttharby{at}bham.ac.uk

Rachel Foskett-Tharby and colleagues draw on recent experience in England to reflect on how best to increase the collection and use of patient reported information

Patient experience and patient centred care have become increasingly recognised as ethical imperatives over the past few decades. Although the definition is still somewhat contested, patient centred care incorporates aspects of the patient experience, such as communication, shared decision making, and the way services are designed, accessed, and delivered, including integration of care.1 Patient experience has also become seen as integral to quality of care,2 leading to calls internationally for measurement and incentive structures to be realigned to place a greater focus on patient reported information. Existing pay for performance schemes such as the Quality and Outcomes Framework (QOF) in England, have been criticised for focusing on clinical management above patient experience.345 However, although it is easy to identify the shortcomings of current incentives, incorporating measures using patient reported information has challenges.6

What is patient reported information?

Patient reported information is that which is gathered directly from patients or their families and carers, either as a narrative or through survey questions. Schlesinger and colleagues suggest that it can be organised into four subtypes: patient reported outcome measures (PROMs), which measure the outcome or effects or care; patient experience measures (PREMs), which measure processes or experience of care; patient narratives; and patient complaints (fig 1).7

Fig 1 Types of patient reported information7

Though not mutually exclusive, these four forms of patient feedback present different challenges when seeking to incorporate them into an incentive structure, to differentiate between high and low performers, or to inform quality improvement efforts. Feedback that can be quantified lends itself most easily to inclusion in an incentive structure as responses are standardised, enable direct comparison between providers, …

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