Impact of Pay for Performance on Ethnic Disparities in Intermediate Outcomes for Diabetes: A Longitudinal Study
Abstract
OBJECTIVE—The purpose of this study was 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 U.K.
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 A1C 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 those predicted by the underlying trend in the white (−5.8 and −4.2 mmHg), black (−2.5 and −2.4 mmHg), and South Asian (−5.5 and −3.3 mmHg) groups. Reductions in A1C levels were significantly greater than those 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 A1C were abolished before the introduction of pay for performance.
CONCLUSIONS—The introduction of a pay for performance incentive in U.K. 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 programs.
Footnotes
-
Published ahead of print at http://care.diabetesjournals.org on 10 December 2008.
This study represents independent research commissioned by the National Institute for Health Research, U.K. The views expressed in this publication are those of the authors and not necessarily those of the U.K. National Health Service, the National Institute for Health Research, or the Department of Health.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
- Accepted November 25, 2008.
- Received May 28, 2008.
- DIABETES CARE
In this Issue
