JRSM > Volume 102, Number 3 > Pp. 103-107

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Impact of pay for performance on quality of chronic disease management by social class group in England

Danielle Crawley¹ Anthea Ng¹ Arch G Mainous, III² Azeem Majeed¹   Christopher Millett¹

¹ Department of Primary Care and Social Medicine, Imperial College, Reynolds Building St Dunstan’s Road, London W6 8RP, UK
² Department of Family Medicine, Medical University of South Carolina Charleston, SC 29425, USA

Correspondence to: Christopher Millett c.millett{at}imperial.ac.uk

Objective To examine associations between social class and achievement of selected national audit targets for coronary heart disease (CHD), diabetes and hypertension in England before and after the introduction of a major pay for performance programme in 2004.

Design Secondary analysis of 2003 and 2006 national survey data for respondents with CHD and diabetes and hypertension.

Setting England.

Main outcome measure Achievement of national audit targets for blood pressure, blood glucose and cholesterol control.

Results There were no significant differences in achievement of blood pressure targets in individuals from manual and non-manual occupational groups with diabetes (2003: 65.9% v 60.3%, 2006: 67.6% v 69.7%) or hypertension (2003: 66.2% v 66.2%, 2006: 72.8% v 71.9%) before or after the introduction of pay for performance. Achievement of the cholesterol target was also similar in individuals from manual and non-manual groups with diabetes (2003: 52.5% v 46.6%, 2006: 68.7% v 70.5%) or CHD (2003: 54.3% v 53.3%, 2006: 68.6% v 71.3%). Differences in achievement of the blood pressure target in CHD [75.8% v 84.5%; AOR 0.44 (0.21-0.90)] were evident between manual and non-manual occupational groups after the introduction of pay for performance.

Conclusion The quality of chronic disease management in England was broadly equitable between socioeconomic groups before this major pay for performance programme and remained so after its introduction.

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