the effects of pay for performance on disparities in stroke, hypertension, and coronary heart disease management interrupted time series study支付性能差异的影响在中风、高血压和冠心病管理中断时间序列研究.pdf

The Effects of Pay for Performance on Disparities in Stroke, Hypertension, and Coronary Heart Disease Management: Interrupted Time Series Study John Tayu Lee*, Gopalakrishnan Netuveli, Azeem Majeed, Christopher Millett Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, United Kingdom Abstract Background: The Quality and Outcomes Framework (QOF), a major pay-for-performance programme, was introduced into United Kingdom primary care in April 2004. The impact of this programme on disparities in health care remains unclear. This study examines the following questions: has this pay for performance programme improved the quality of care for coronary heart disease, stroke and hypertension in white, black and south Asian patients? Has this programme reduced disparities in the quality of care between these ethnic groups? Did general practices with different baseline performance respond differently to this programme? Methodology/Principal Findings: Retrospective cohort study of patients registered with family practices in Wandsworth, London during 2007. Segmented regression analysis of interrupted time series was used to take into account the previous time trend. Primary outcome measures were mean systolic and diastolic blood pressure, and cholesterol levels. Our findings suggest that the implementation of QOF resulted in significant short term improvements in blood pressure control. The magnitude of benefit varied between ethnic groups with a statistically significant short term reduction in systolic BP in white and black but not in south Asian patients with hypertension. Disparities in risk factor control were attenuated only on few measures and largely remained intact at the end of the study period. Conclusions/Significance: Pay for performance programmes such