Use of interval based quality indicators in blood pressure management to enhance quality of pay for performance incentives: comparison to two indicators from the Quality and Outcomes Framework.
BACKGROUND
Pay for performance incentives are becoming increasingly popular, but are typically based on only a single point-in-time measurement as an indicator of chronic condition management.


OBJECTIVE
To determine the association between three time-interval based indicators of suboptimal blood pressure (BP) control and two point-in-time indicators from the UK Quality and Outcomes Framework (QOF): BP5 (the percentage of patients with hypertension in whom the last BP in the previous nine months was < or = 150/90) and DM12 (the percentage of patients with diabetes in whom the last BP in the previous 15 months was < or = 145/85).


METHODS
We extracted classification data and BP measurements from four New Zealand general practices with 4260 to 6130 enrolled patients. Data were analysed for three indicators with respect to a nine-month evaluation period for patients with hypertension and a 15-month period for patients with diabetes: (1) two or more consistently high BP measurements spaced over > or = 90 days, (2) a high BP measurement followed by a lapse of >120 days in BP measurement and (3) no BP measurement for >180 days.


RESULTS
For the four practices, 65-81% of the patients satisfied BP5 and 59-68% of patients satisfied DM12. Of the hypertension patients satisfying BP5, 31% (95% CI: 28-33%) failed at least one of the three interval based indicators; 42% (95% CI: 39-46%) of the diabetes patients satisfying DM12 failed at least one of the three interval based indicators.


CONCLUSIONS
Considering only a point-in-time controlled BP measurement provides an incomplete view of the quality of BP management in patients with hypertension or diabetes over a period of time.
Mabotuwana
Thusitha
T
Department of Computer Science - Tamaki Campus and National Institute for Health Innovation/Section for Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand.
Warren
Jim
J
Elley
C Raina
CR
Kennelly
John
J
Paton
Chris
C
Warren
Debra
D
Chang Wai
Kuinileti
K
Wells
Stewart
S
D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000191:economics / Q000592:standards*; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive / Q000592:standards*