RT Journal Article
SR Electronic
T1 Effect of a UK Pay-for-Performance Program on Ethnic Disparities in Diabetes Outcomes: Interrupted Time Series Analysis
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 228
OP 234
DO 10.1370/afm.1335
VO 10
IS 3
A1 Alshamsan, Riyadh
A1 Lee, John Tayu
A1 Majeed, Azeem
A1 Netuveli, Gopalakrishnan
A1 Millett, Christopher
YR 2012
UL http://www.annfammed.org/content/10/3/228.abstract
AB PURPOSE We wanted to examine the long-term effects of the Quality and Outcomes Framework (QOF), a major pay-for-performance program in the United Kingdom, on ethnic disparities in diabetes outcomes. METHODS We undertook an interrupted time series analysis of electronic medical record data of diabetes patients registered with 29 family practices in South West London, United Kingdom. Main outcome measures were mean hemoglobin A1c (HbA1c), total cholesterol, and blood pressure. RESULTS The introduction of QOF was associated with initial accelerated improvements in systolic blood pressure in white and black patients, but these improvements were sustained only in black patients (annual decrease: −1.68 mm Hg; 95% CI, −2.41 to −0.95 mm Hg). Initial improvements in diastolic blood pressure in white patients (−1.01 mm Hg; 95% CI, −1.79 to −0.24 mm Hg) and in cholesterol in white (−0.13 mmol/L; 95% CI, −0.21 to −0.05 mmol/L) and black (−0.10 mmol/L; 95% CI, −0.20 to −0.01 mmol/L) patients were not sustained in the post-QOF period. There was no beneficial impact of QOF on HbA1c in any ethnic group. Existing disparities in risk factor control remained largely intact (for example; mean HbA1c: white 7.5%, black 7.8%, south Asian 7.8%; P <.05) at the end of the study period. CONCLUSION A universal pay-for-performance scheme did not appear to address important disparities in chronic disease management over time. Targeted quality improvement strategies may be required to improve health care in vulnerable populations.