journal.pmed.0040191.pdf (107.21 kB)
Ethnic disparities in diabetes management and pay-for-performance in the UK: the Wandsworth Prospective Diabetes Study.
journal contribution
posted on 2012-10-24, 09:02 authored by C. Millett, J. Gray, S. Saxena, G. Netuveli, Kamlesh Khunti, A. MajeedPay-for-performance rewards health-care providers by paying them more if they succeed in meeting performance targets. A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay-for-performance seen in any health-care system. The contract provides an important opportunity to address disparities in chronic disease management between ethnic and socioeconomic groups. We examined disparities in management of people with diabetes and intermediate clinical outcomes within a multiethnic population in primary care before and after the introduction of the new contract in April 2004.
Background
Pay-for-performance rewards health-care providers by paying them more if they succeed in meeting performance targets. A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay-for-performance seen in any health-care system. The contract provides an important opportunity to address disparities in chronic disease management between ethnic and socioeconomic groups. We examined disparities in management of people with diabetes and intermediate clinical outcomes within a multiethnic population in primary care before and after the introduction of the new contract in April 2004.
Methods and Findings
We conducted a population-based longitudinal survey, using electronic general practice records, in an ethnically diverse part of southwest London. Outcome measures were prescribing levels and achievement of national treatment targets (HbA1c ≤ 7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol ≤ 5 mmol/l or 193 mg/dl). The proportion of patients reaching treatment targets for HbA1c, BP, and total cholesterol increased significantly after the implementation of the new contract. The extents of these increases were broadly uniform across ethnic groups, with the exception of the black Caribbean patient group, which had a significantly lower improvement in HbA1c (adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.57–0.97) and BP control (AOR 0.65, 95% CI 0.53–0.81) relative to the white British patient group. Variations in prescribing and achievement of treatment targets between ethnic groups present in 2003 were not attenuated in 2005.
Conclusions
Pay-for-performance incentives have not addressed disparities in the management and control of diabetes between ethnic groups. Quality improvement initiatives must place greater emphasis on minority communities to avoid continued disparities in mortality from cardiovascular disease and the other major complications of diabetes.
Funding
The Wandsworth Primary Care Research Centre and the Wandsworth Prospective Diabetes Study are funded by the Department of Health. The Wandsworth Prospective Diabetes Study has also received support from the Medical Research Council through the Virtual Organisation of Trials and Epidemiological Studies (VOTES) project.
History
Citation
PLoS Medicine, 2007, 4 (6), pp. e191-e191Published in
PLoS MedicinePublisher
Public Library of Scienceissn
1549-1277eissn
1549-1676Copyright date
2007Available date
2012-10-24Publisher DOI
Publisher version
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0040191Language
engAdministrator link
Usage metrics
Categories
Keywords
AdultAfricaAged80 and overBangladeshBlood PressureCaribbean RegionCholesterolContractsDiabetes MellitusDisease ManagementEthnic GroupsFamily PracticeFemaleGoalsGreat BritainHealth PolicyHemoglobin AGlycosylatedHumansIndiaLondonMaleMedical Records SystemsComputerizedMiddle AgedNational Health ProgramsOutcome Assessment (Health Care)PakistanPhysician Incentive PlansPhysiciansFamilyPractice ManagementMedicalPrejudiceProspective StudiesQuality IndicatorsHealth CareReimbursementIncentiveTreatment Outcome
Licence
Exports
RefWorks
BibTeX
Ref. manager
Endnote
DataCite
NLM
DC