Skip to main content

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.

Comments

Post a Comment

Popular posts from this blog

Protecting Against the "Quad-demic": Influenza, Covid-19, Norovirus and RSV

As the NHS braces for a challenging winter season, it is grappling with a "quad-demic" of health emergencies caused by influenza, Covid-19, norovirus, and respiratory syncytial virus (RSV). This confluence of viral threats poses a significant risk to public health in the UK as well as putting strain on healthcare resources, emphasising the importance of preventive measures to safeguard public health. Public health measures such a vaccination and good personal hygiene are pivotal in reducing the impact of these illnesses, particularly for vulnerable groups. The Four Viruses: What Are They? Influenza: A highly contagious respiratory infection that causes significant illness each winter. It can lead to severe complications, particularly in the elderly, young children, pregnant women, and those with chronic health conditions. Covid-19: Though its most acute phase has passed, Covid-19 remains a concern, especially as new variants of SA...
Post a Comment
Read more

MPH Student Presentations on the NHS Care.Data Programme

As part of a session on primary care data in the Health Informatics module on the Imperial Master of Public Health Programme, I asked students to work in two groups to present arguments for and against the NHS Care.Data programme. Care.Data is an NHS programme that will extract data from the medical records held by general practitioners (GPs) in England. The Care.Data programme takes advantage of the very high level of use of electronic medical records by GPs in England. After extraction, data will be uploaded to the NHS Health and Social Care Information Centre (HSCIC). The data will then be used for functions such as health care planning, monitoring disease patterns and research. The programme has been controversial with proponents arguing that the programme will bring many benefits for the NHS and the population of England; and opponents arguing it is a major breach of privacy. You can view the two presentations to help inform you further about these arguments: Arguments fo...
5 comments
Read more

The Hidden Cost of Cheaper NHS Contracts: Losing Community Trust

NHS budgets are under considerable pressure. It is therefore unsurprising that many NHS Integrated Care Boards (ICBs) In England will aim to prioritise price in contract awards, But this approach is a significant threat to community-centred healthcare. While competitive tendering is a legally required, an excessive focus on costs in awarding NHS contracts risks overshadowing key factors such as established community trust, local expertise, and the long-term impact on continuity of care. This shift towards cheaper, often external, commercial providers threatens to cut the links between communities and their local health services. The argument that competitive tendering is solely about legal compliance, and not cost, is undermined by the very nature of such tendering, which by design encourages the lowest bid. This approach risks eroding the social fabric of local healthcare provision, where established relationships and understanding of specific community needs are essential. Establishe...
1 comment
Read more