RT Journal Article
SR Electronic
T1 Association of practice size and pay-for-performance incentives with the quality of diabetes management in primary care
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP cmaj.101187
DO 10.1503/cmaj.101187
A1 Vamos, Eszter P.
A1 Pape, Utz J.
A1 Bottle, Alex
A1 Hamilton, Fiona Louise
A1 Curcin, Vasa
A1 Ng, Anthea
A1 Molokhia, Mariam
A1 Car, Josip
A1 Majeed, Azeem
A1 Millett, Christopher
YR 2011
UL http://www.cmaj.ca/content/early/2011/08/02/cmaj.101187.abstract
AB Background: Not enough is known about the association between practice size and clinical outcomes in primary care. We examined this association between 1997 and 2005, in addition to the impact of the Quality and Outcomes Framework, a pay-for-performance incentive scheme introduced in the United Kingdom in 2004, on diabetes management. Methods: We conducted a retrospective opencohort study using data from the General Practice Research Database. We enrolled 422 general practices providing care for 154 945 patients with diabetes. Our primary outcome measures were the achievement of national treatment targets for blood pressure, glycated hemoglobin (HbA1c) levels and total cholesterol. Results: We saw improvements in the recording of process of care measures, prescribing and achieving intermediate outcomes in all practice sizes during the study period. We saw improvement in reaching national targets after the introduction of the Quality and Outcomes Framework. These improvements significantly exceeded the underlying trends in all practice sizes for achieving targets for cholesterol level and blood pressure, but not for HbA1c level. In 1997 and 2005, there were no significant differences between the smallest and largest practices in achieving targets for blood pressure (1997 odds ratio [OR] 0.98, 95% confidence interval [CI] 0.82 to 1.16; 2005 OR 0.92, 95% CI 0.80 to 1.06 in 2005), cholesterol level (1997 OR 0.94, 95% CI 0.76 to 1.16; 2005 OR 1.1, 95% CI 0.97 to 1.40) and glycated hemoglobin level (1997 OR 0.79, 95% CI 0.55 to 1.14; 2005 OR 1.05, 95% CI 0.93 to 1.19). Interpretation: We found no evidence that size of practice is associated with the quality of diabetes management in primary care. Pay-forperformance programs appear to benefit both large and small practices to a similar extent.