gms | German Medical Science

G-I-N Conference 2012

Guidelines International Network

22.08 - 25.08.2012, Berlin

Performance measures and quality of evidence: a case study of depression pay for performance measures

Meeting Abstract

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  • E. Shaw - NICE, Manchester, UK
  • D. Sutcliffe - NICE, Manchester, UK
  • T. Lacey - NICE, Manchester, UK
  • T. Stokes - NICE, Manchester, UK

Guidelines International Network. G-I-N Conference 2012. Berlin, 22.-25.08.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocP172

doi: 10.3205/12gin284, urn:nbn:de:0183-12gin2840

Published: July 10, 2012

© 2012 Shaw et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: Performance measures (PMs) can be used to judge and reward care quality, through pay for performance (P4P). Arguably, evidence robustness that exceeds that for guideline development is appropriate for measures used in national programmes of quality improvement, since these can affect thousands of providers and millions of patients. There is also significant potential for P4P to have unintended consequences through incentivising inappropriate care.

Objectives: To describe how evidence was used to review national P4P PMs that incentivise structured assessment of depression severity in primary care through routine use of questionnaires.

Methods: We reviewed severity assessment, depression outcomes and unintended consequences and presented findings using GRADE profiles.

Results: Very low-quality evidence showed structured severity assessment at diagnosis leads to appropriate intervention. No evidence on whether structured severity assessment and subsequent treatment resulted in improved health outcomes was found. Patients and general practitioners (GPs) had different perceptions, with patients being more positive. GPs considered there were associated unintended consequences. No evidence on how severity assessment at follow-up affects health outcomes/processes was identified. Patients considered assessment at follow-up as useful and reflected experiences of depression over time. No evidence on GP views was identified.

Discussion: Any estimate of effect of structured depression severity assessment in general practice is uncertain. GPs consider routine use of questionnaires as incentivized by the indicators has unintended consequences which could adversely affect patient care.

Implications for guideline developers/users: Future PMs should have evidence showing improved health outcomes and be piloted before introduction to minimize unintended consequences.