title: The effects of pay for performance on disparities in stroke, hypertension, and coronary heart disease management: interrupted time series study.
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?
  
  
  RESULTS
  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
  Pay for performance programmes such as the QOF in the UK should set challenging but achievable targets. Specific targets aimed at reducing ethnic disparities in health care may also be needed.
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, United Kingdom. t.lee@imperial.ac.uk
authors.forename: John Tayu
authors.initials: JT
authors.lastname: Lee
authors.forename: Gopalakrishnan
authors.initials: G
authors.lastname: Netuveli
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
authors.forename: Christopher
authors.initials: C
authors.lastname: Millett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003327:Coronary Disease / Q000097:blood / Q000191:economics* / Q000208:ethnology; D019468:Disease Management; D005260:Female; D058005:General Practitioners; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000208:ethnology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics; D011787:Quality of Health Care / Q000191:economics; D012052:Reimbursement, Incentive / Q000191:economics*; D020521:Stroke / Q000097:blood / Q000191:economics* / Q000208:ethnology; D013997:Time Factors; D055815:Young Adult
chemical_list: D002784:Cholesterol