Document Detail


Effect of a UK pay-for-performance program on ethnic disparities in diabetes outcomes: interrupted time series analysis.
MedLine Citation:
PMID:  22585887     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 A(1c) (HbA(1c)), 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 HbA(1c) in any ethnic group. Existing disparities in risk factor control remained largely intact (for example; mean HbA(1c): 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.
Authors:
Riyadh Alshamsan; John Tayu Lee; Azeem Majeed; Gopalakrishnan Netuveli; Christopher Millett
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of family medicine     Volume:  10     ISSN:  1544-1717     ISO Abbreviation:  Ann Fam Med     Publication Date:    2012 May-Jun
Date Detail:
Created Date:  2012-05-15     Completed Date:  2012-09-06     Revised Date:  2013-06-25    
Medline Journal Info:
Nlm Unique ID:  101167762     Medline TA:  Ann Fam Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  228-34     Citation Subset:  IM    
Affiliation:
Department of Primary Care and Public Health, Imperial College, St. Dunstan's Road, London, United Kingdom. ra105@imperial.ac.uk
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MeSH Terms
Descriptor/Qualifier:
African Continental Ancestry Group
Blood Pressure
Cholesterol
Diabetes Mellitus*
Ethnic Groups*
European Continental Ancestry Group
Family Practice / economics*,  standards
Female
Great Britain
Healthcare Disparities / economics*
Hemoglobin A, Glycosylated
Humans
Linear Models
Male
Middle Aged
Quality of Health Care / economics*,  standards
Reimbursement, Incentive / economics*
Treatment Outcome
Grant Support
ID/Acronym/Agency:
//Department of Health
Chemical
Reg. No./Substance:
0/Hemoglobin A, Glycosylated; 57-88-5/Cholesterol
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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