Key research questions
1. What can be learned from international P4Q models on the design, implementation and evaluation?
a. Design and implementation. Which conceptual framework is recommendable for use in Belgian healthcare (including the definition of quality of care)? What are the current system components of a P4Q program? How are financial incentives designed? What are the critical success factors for the implementation of a P4Q program? Is a staged approach preferential? Etc. The 'design' and 'implementation' dimensions of the P4P checklist developed by Dudley and Rosenthal (2006) gives a more comprehensive overview of relevant questions, although not being exhaustive. The KCE-PPF also formulates the relevant question how patients are incorporated in the process. This will also be addressed.
b. Evaluation. What are the effects of the use of a P4Q program, focusing on all relevant quality domains (including access, coordination, cost-effectiveness,...) and also taking into account unintended consequences?
2. What are the conditions to apply international P4Q models or to enlarge Belgian quality improving experiments?
a. Design, implementation, evaluation. What are the current initiatives in Belgium in the public and private sector to enhance quality of care by way of financial incentives linked to quality of care measures? Is there any evidence of their impact on quality?
b. Conditions. To what extent are the current financing scheme, databases and other tools (guidelines, quality indicators) appropriate to implement P4Q in the Belgian health care setting? What are the most important facilitating and hindering factors?

Narrowing the focus to primary care and hospital care: These research questions are relevant to the divers types of healthcare: general and mental health care, primary care and hospital care. The IOM report on P4Q gives some examples of programs in skilled nursing facilities and home health agencies. Initiatives in these settings are however still rare and often lack the availability of quality of care data.