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Effect of Pay-for-Performance on Ethnic Disparities in Diabetes Outcomes


The United Kingdom's Quality and Outcomes Framework (QOF) is a pay-for-performance program that rewards family practitioners in the United Kingdom for the achievement of quality standards. The impact of such quality improvement strategies on disparities in health care is unclear. In an article published in the journal Annals of Family Medicine, Riyadh Alshamsan and colleagues carried out an interrupted time series analysis to examine the impact of QOF on ethnic disparities in diabetes outcomes, using data from the electronic medical records diabetes patients registered with 29 family practices in South West London. The main outcome measures examined were mean haemoglobin A1c (HbA1c), total cholesterol, and blood pressure.

They found that the introduction of QOF was associated with initial accelerated improvements in systolic blood pressure in white and black patients, but these improvements were sustained only in black patients . Initial improvements in diastolic blood pressure in white patients and in cholesterol in white and black patients were not sustained in the post-QOF period. There was no beneficial impact of QOF on HbA1c in any ethnic group. Existing disparities in risk factor control largely remained. They concluded that a universal pay-for-performance scheme did not address important disparities in diabetes management and that more targeted quality improvement strategies may be required to improve health care in vulnerable populations.

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