Millett Christopher, Netuveli Gopalakrishnan, Saxena Sonia, Majeed Azeem
Department of Primary Care and Social Medicine, Imperial College Faculty of Medicine, London, UK.
Diabetes Care. 2009 Mar;32(3):404-9. doi: 10.2337/dc08-0912. Epub 2008 Dec 10.
The purpose of this study was to examine the impact of a major pay for performance incentive on trends in the quality of diabetes care in white, black, and South Asian ethnic groups in an urban setting in the U.K.
We developed longitudinal models examining the quality of diabetes care in a cohort of ethnically diverse patients in Southwest London using electronic family practice records. Outcome measures were mean blood pressure and A1C values between 2000 and 2005.
The introduction of pay for performance was associated with reductions in mean systolic and diastolic blood pressure, which were significantly greater than those predicted by the underlying trend in the white (-5.8 and -4.2 mmHg), black (-2.5 and -2.4 mmHg), and South Asian (-5.5 and -3.3 mmHg) groups. Reductions in A1C levels were significantly greater than those predicted by the underlying trend in the white group (-0.5%) but not in the black (-0.3%) or South Asian (-0.4%) groups. Ethnic group disparities in annual measurement of blood pressure and A1C were abolished before the introduction of pay for performance.
The introduction of a pay for performance incentive in U.K. primary care was associated with improvements in the intermediate outcomes of diabetes care for all ethnic groups. However, the magnitude of improvement appeared to differ between ethnic groups, thus potentially widening existing disparities in care. Policy makers should consider the potential impacts of pay for performance incentives on health disparities when designing and evaluating such programs.
本研究旨在探讨一项主要的绩效薪酬激励措施对英国城市环境中白人、黑人和南亚族裔糖尿病护理质量趋势的影响。
我们利用电子家庭医疗记录，开发了纵向模型，以研究伦敦西南部一群不同种族患者的糖尿病护理质量。结果指标为2000年至2005年期间的平均血压和糖化血红蛋白（A1C）值。
实施绩效薪酬与平均收缩压和舒张压的降低相关，白人组（-5.8和-4.2 mmHg）、黑人组（-2.5和-2.4 mmHg）和南亚组（-5.5和-3.3 mmHg）的降幅显著大于潜在趋势预测的降幅。糖化血红蛋白水平的降低显著大于白人组潜在趋势预测的降幅（-0.5%），但黑人组（-0.3%）和南亚组（-0.4%）并非如此。在实施绩效薪酬之前，血压和糖化血红蛋白年度测量中的种族差异消失了。
在英国初级医疗中引入绩效薪酬激励措施与所有种族糖尿病护理的中间结果改善相关。然而，各民族之间的改善程度似乎有所不同，因此可能会扩大现有的护理差距。政策制定者在设计和评估此类项目时应考虑绩效薪酬激励措施对健康差距的潜在影响。
