Abstract

Objective: To examine the impact of a major pay for performance incentive on trends in the quality of diabetes care in white, black and south Asian ethnic groups in an urban setting in the UK.

Research Design and Methods: We developed longitudinal models examining the quality of diabetes care in a cohort of ethnically diverse patients in southwest London using electronic family practice records. Outcome measures were mean blood pressure and HbA1c values between 2000 and 2005.

Results: The introduction of pay for performance was associated with reductions in mean systolic and diastolic blood pressure which were significantly greater than that predicted by the underlying trend in the white (−5.8 mm Hg, −4.2 mm Hg), black (−2.5 mm Hg, −2.4 mm Hg) and south Asian (−5.5 mm Hg, −3.3 mm Hg) groups. Reductions in HbA1c levels were significantly greater than that predicted by the underlying trend in the white group (−0.5%) but not in the black (−0.3%) or south Asian (−0.4%) groups. Ethnic group disparities in annual measurement of blood pressure and HbA1c were abolished before the introduction of pay for performance.

Conclusions: The introduction of a pay for performance incentive in UK primary care was associated with improvements in the intermediate outcomes of diabetes care for all ethnic groups. However, the magnitude of improvement appeared to differ between ethnic groups, thus potentially widening existing disparities in care. Policy makers should consider the potential impacts of pay for performance incentives on health disparities when designing and evaluating such programmes.