Population intermediate outcomes of diabetes under pay for performance incentives in England from 2004 to 2008

Abstract

Objective: To evaluate diabetes outcomes under a national ‘pay-for-performance’ program.

Research Design and Methods: Data were analysed for 98% of all English family practices. For each practice, the proportion of diabetes subjects with HbA1c ≤7.5%, blood pressure ≤145/85mm Hg and cholesterol ≤5mmol/l was determined. Practices achieving less than the 25th centile for the HbA1c target for 2006-7 were classed as low-performing.

Results: The proportion achieving the HbA1c target at the median practice increased from 59.1% (interquartile range, IQR 51.7%-65.9%) in 2004-5 to 66.7% (IQR 60.6%-72.7%) in 2007-8; blood pressure from 70.9% in 2004-5 to 80.2% in 2007-8; cholesterol from 72.6% in 2004-5 to 83.6% in 2007-8. In 2004-5, 57% of practices were low-performing, (range by region, 42.4%-69.9%). In 2007-8, 26% of practices were low-performing (range 11.6%-37.5%).

Conclusion: Introduction of pay-for-performance may be one factor contributing to increasing achievement of targets and reducing problems of low performance.