Evaluation of a system of monitoring allied health service provision, quality and outcomes

Abstract

Allied health professionals provide a diverse
range of patient care. However funders and purchasers of allied
health services have few mechanisms for defining the
interventions carried out by allied health providers; for defining
episodic care; or for monitoring the quality and outcomes of
allied health provider interventions. As a result, third party
funders tend to allocate allied health services by establishing a
ceiling on the number of appointments allowed, or “capping
care” regardless of the condition or patient need. This paper
reports on the effect of the monitoring systems by a third party
funder to introduce more patient centred funding models. Aim:
To evaluate a system of monitoring allied health service
provision, quality and outcomes. Method: A large third party
funder piloted the introduction of a comprehensive care planning
tool to investigate the potential for post-payment monitoring of
service quality. Results: Practitioner perceptions of provider
quality were quite different from what was measured and
audited. The heterogeneity of allied health services means that no
standardised classification system of interventions is appropriate
for service benchmarking. There were large variations in service
provision, within and between practitioners. Conclusions:
Ongoing monitoring should include easily auditable measures,
such as occasions of service mapped against broad indicators of
type of appointment. There is a need for ongoing systems of
quality improvement to ensure the quality of patient care is
optimised.