The Quality System and Impact of Different Patient and Practice-Related Characteristics on a Good Outcome

Background: Payment-for-performance for family doctors (FD), also called the quality system (QS), and was implemented in 2006 in Estonia. Several patient and practice-related characteristics are described to have an impact on a good quality outcome. Intensive screening of risk factors of chronic diseases from FDs’ lists can increase the number of disease diagnosed patients on a FD’s list. The first aim of this study was to find out which patient and practice-related characteristics have an impact on a good outcome. The second aim was to assess the influence of the QS on a number of disease diagnosed patients on the FDs’ list. Methods: The study was conducted using the database from the Estonian Health Insurance Fund. FDs were divided in two groups (with “good” and “poor” outcomes) according their achievements in the QS. The study compared 15 patient and practice-related characteristics during the observation period 2006–2012. Data also included the number of disease diagnosed patients on a FD’s list and we compared them during the observation period. Results: During the observation period 2006–2012, the number of FDs with a good outcome in the QS increased. FDs who had longer experience of participation in the QS showed better results, and the number of FDs in primary care teams has an impact on a good outcome. The number of patients on FDs’ lists and number of patients with different chronic diseases have no impact on a good outcome. The number of disease diagnosed patients on a FD’s list increased during a study period as well. Conclusions: Several patient and practice-related characteristic scan have an influence on FDs performance in a QS. As workload increases, to maintain a good outcome smaller lists of FDs patients or increased staff levels are needed.