Population Intermediate Outcomes of Diabetes Under Pay-for-Performance Incentives in England From 2004 to 2008

OBJECTIVE - To evaluate diabetes outcomes under a national pay-for-performance program. RESEARCH DESIGN AND METHODS - Data were analyzed for 98% of all English family practices. For each practice, the proportion of diabetic subjects with AlC <= 7.5%, blood pressure <= 145/85 mmHg, and cholesterol <= 5 mmol/l was determined. Practices achieving less than the 25th centile for the AlC target for 2000-2007 were classified as low performing. RESULTS - The proportion achieving the AlC target at the median practice increased from 59.1% (interquartile range (IQR) 51.7-65.9) in 2004-2005 to 66.7% (IQR 60.6-72.7) in 2007-2008, blood pressure from 70.9% in 2004-2005 to 80.2% in 2007-2008, and cholesterol from 72.6% in 2004-2005 to 83.6% in 2007-2008. In 2004-2005, 57% of practices were low performing (range by region 42.4-69.9). In 2007-2008, 26% of practices were low performing (range 11.6-37.5). CONCLUSIONS - introduction of pay-for-performance may be one factor contributing to increasing achievement of target,, and reducing problems of low performance.