Impact of pay for performance on quality of chronic disease management by social class group in England.
OBJECTIVE
To examine associations between social class and achievement of selected national audit targets for coronary heart disease (CHD), diabetes and hypertension in England before and after the introduction of a major pay for performance programme in 2004.


METHODS
Secondary analysis of 2003 and 2006 national survey data for respondents with CHD and diabetes and hypertension.


METHODS
England.


METHODS
Achievement of national audit targets for blood pressure, blood glucose and cholesterol control.


RESULTS
There were no significant differences in achievement of blood pressure targets in individuals from manual and non-manual occupational groups with diabetes (2003: 65.9% v 60.3%, 2006: 67.6% v 69.7%) or hypertension (2003: 66.2% v 66.2%, 2006: 72.8% v 71.9%) before or after the introduction of pay for performance. Achievement of the cholesterol target was also similar in individuals from manual and non-manual groups with diabetes (2003: 52.5% v 46.6%, 2006: 68.7% v 70.5%) or CHD (2003: 54.3% v 53.3%, 2006: 68.6% v 71.3%). Differences in achievement of the blood pressure target in CHD [75.8% v 84.5%; AOR 0.44 (0.21-0.90)] were evident between manual and non-manual occupational groups after the introduction of pay for performance.


CONCLUSIONS
The quality of chronic disease management in England was broadly equitable between socioeconomic groups before this major pay for performance programme and remained so after its introduction.
Crawley
Danielle
D
Department of Primary Care and Social Medicine, Imperial College, Reynolds Building, St Dunstan's Road, London W6 8RP, UK.
Ng
Anthea
A
Mainous
Arch G
AG
Majeed
Azeem
A
Millett
Christopher
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose; D001794:Blood Pressure / Q000502:physiology; D002908:Chronic Disease; D003327:Coronary Disease / Q000191:economics / Q000628:therapy*; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D004739:England; D006291:Health Policy; D006801:Humans; D006937:Hypercholesterolemia / Q000191:economics / Q000517:prevention & control; D006973:Hypertension / Q000628:therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008875:Middle Aged; D011787:Quality of Health Care; D012923:Social Class; D055815:Young Adult
D000959:Antihypertensive Agents; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents