A comparison of chronic illness care quality in US and UK family medicine practices prior to pay-for-performance initiatives.
BACKGROUND
The Quality and Outcomes Framework (QOF) has contributed to modest improvements in chronic illness care in the UK. US policymakers have proposed similar pay-for-performance (P4P) approaches to improve care. Since previous studies have not compared chronic illness care quality in US and UK primary care practices prior to the QOF, the relative preparedness of practices to respond to P4P incentives is unknown.


OBJECTIVE
To compare US and UK practices on P4P measures prior to program implementation.


METHODS
We analysed medical record data collected before QOF implementation from randomly selected patients with diabetes or coronary artery disease (CAD) in 42 UK and 55 US family medicine practices. We compared care processes and intermediate outcomes using hierarchical logistic regression.


RESULTS
While we found gaps in chronic illness care quality across both samples, variation was lower in UK practices. UK patients were more likely to receive recommended care processes for diabetes [odds ratio (OR), 8.94; 95% confidence interval (CI), 4.26-18.74] and CAD (OR, 9.18; 95% CI, 5.22-16.17) but less likely to achieve intermediate diabetes outcome targets (OR, 0.50; 95% CI, 0.39-0.64).


CONCLUSIONS
Following National Health Service (NHS) investment in primary care preparedness, but prior to the QOF, UK practices provided more standardized care but did not achieve better intermediate outcomes than a sample of typical US practices. US policymakers should focus on reducing variation in care documentation to ensure the effectiveness of P4P efforts while the NHS should focus on moving from process documentation to better patient outcomes.
Crosson
Jesse C
JC
Research Division, Department of Family Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Somerset, NJ 08873, USA. jesse.crosson@umdnj.edu
Ohman-Strickland
Pamela A
PA
Campbell
Stephen
S
Phillips
Robert L
RL
Roland
Martin O
MO
Kontopantelis
Evangelos
E
Bazemore
Andrew
A
Balasubramanian
Bijal
B
Crabtree
Benjamin F
BF
D002908:Chronic Disease / Q000628:therapy*; D005194:Family Practice; D006801:Humans; D007407:Interviews as Topic; D011785:Quality Assurance, Health Care; D012052:Reimbursement, Incentive; D006113:United Kingdom; D014481:United States