Ethnic disparities in coronary heart disease management and pay for performance in the UK

Abstract

Background: Few pay for performance schemes have been subject to rigorous evaluation, and their impact on disparities in chronic disease management is uncertain.

Objective: To examine disparities in coronary heart disease management and intermediate clinical outcomes within a multiethnic population before and after the introduction of a major pay for performance initiative in April 2004.

Design: Comparison of two cross-sectional surveys using electronic general practice records.

Setting: Thirty-two family practices in south London, United Kingdom (UK).

Patients: Two thousand eight hundred and ninety-one individuals with coronary heart disease registered with participating practices in 2003 and 3,101 in 2005.

Measurements: Percentage achievement by ethnic group of quality indicators in the management of coronary heart disease

Results: The proportion of patients reaching national treatment targets increased significantly for blood pressure (51.2% to 58.9%) and total cholesterol (65.7% to 73.8%) after the implementation of a major pay for performance initiative in April 2004. Improvements in blood pressure control were greater in the black group compared to whites, with disparities evident at baseline being attenuated (black 54.8% vs. white 58.3% reaching target in 2005). Lower recording of blood pressure in the south Asian group evident in 2003 was attenuated in 2005. Statin prescribing remained significantly lower (p < 0.001) in the black group compared with the south Asian and white groups after the implementation of pay for performance (black 74.8%, south Asian 83.8%, white 80.2% in 2005).

Conclusions: The introduction of pay for performance incentives in UK primary care has been associated with better and more equitable management of coronary heart disease across ethnic groups.