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We think that this strategy based on combining local change standards to the use of shared evidence based indicators kept the integrity of the intervention in each site.
Some diagnoses, such as schizophrenia, are associated with an increase risk of Polypharmacy but there is a lack of evidence based indicators that allows for quality evaluation on this practice.
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This incentive programme includes several detailed evidence based clinical indicators for the management of chronic disease, and performance on these indicators to specified thresholds triggers additional payments to practices.
The Institute of Medicine (IOM), in a report entitled "Emergency Medical Services at the Crossroads" and published in 2006, recommended the development of "evidence based performance indicators that can be nationally standardized so that statewide and national comparisons can be made" [10].
A fundamental research question concerned the effect of this national intervention on quality of care, as measured by the evidence based clinical indicators included in the incentivisation scheme.
Of these 9 indicators, 7 are population based indicators and 2 are facility based indicators.
Organisational structures, systems and standards include: a patient focus, risk management, relevant policies, evidence based practice standards, clinical indicators, regulation, training, monitoring and compliance [ 2, 10, 11].
An important feature of these developed indicators is that they are evidence based, systematically combining evidence-based recommendations from clinical guidelines with expert clinical opinion.
The 8 key recommendations which were deduced from the literature [ 14] were considered as indicators for evidence based best practice.
6 Every attempt was made to ensure the indicators were evidence based (by basing the initial drafting on national clinical guidelines prepared by NICE).
Following admission to wound clinics, implementation of key indicators of evidence based care increased (p < 0.001) and Kaplan-Meier survival analysis found the median time to healing was 12 weeks (95% CI 9.3 14.7).
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