Population Intermediate Outcomes of Diabetes Under Pay-for-Performance Incentives in England From 2004 to 2008
- Pooja Vaghela, MPHARM1,
- Mark Ashworth, MD2,
- Peter Schofield, PHD2 and
- Martin C. Gulliford, FFPH1
- 1Department of Public Health Sciences, King's College London, London, U.K.
- 2Department of Primary Care and General Practice, King's College London, London, U.K.
- Corresponding author: Martin C. Gulliford, martin.gulliford{at}kcl.ac.uk
Abstract
OBJECTIVE—To evaluate diabetes outcomes under a national “pay-for-performance” program.
RESEARCH DESIGN AND METHODS—Data were analyzed for 98% of all English family practices. For each practice, the proportion of diabetic subjects with A1C ≤7.5%, blood pressure ≤145/85 mmHg, and cholesterol ≤5 mmol/l was determined. Practices achieving less than the 25th centile for the A1C target for 2006–2007 were classified as low performing.
RESULTS—The proportion achieving the A1C target at the median practice increased from 59.1% (interquartile range [IQR] 51.7–65.9) in 2004–2005 to 66.7% (IQR 60.6–72.7) in 2007–2008, blood pressure from 70.9% in 2004–2005 to 80.2% in 2007–2008, and cholesterol from 72.6% in 2004–2005 to 83.6% in 2007–2008. In 2004–2005, 57% of practices were low performing (range by region 42.4–69.9). In 2007–2008, 26% of practices were low performing (range 11.6–37.5).
CONCLUSIONS—Introduction of pay-for-performance may be one factor contributing to increasing achievement of targets and reducing problems of low performance.
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 23 December 2008.
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- Accepted December 11, 2008.
- Received November 6, 2008.
- DIABETES CARE
