Family Practice Advance Access originally published online on September 11, 2009
Family Practice 2009 26(6):510-516; doi:10.1093/fampra/cmp056
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A comparison of chronic illness care quality in US and UK family medicine practices prior to pay-for-performance initiatives
a Research Division, Department of Family Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Somerset, NJ
b Department of Biostatistics, University of Medicine and Dentistry of New Jersey-School of Public Health, Piscataway, NJ, USA
c National Primary Care Research and Development Centre, University of Manchester, UK
d Policy Studies in Family Medicine and Primary Care, Robert Graham Center, Washington, DC, USA
Correspondence to Jesse C Crosson, Research Division, Department of Family Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, 1 World's Fair Drive, Room 1500, Somerset, NJ 08873, USA; E-mail: jesse.crosson{at}umdnj.edu
Received 15 December 2008; Revised 20 August 2009; Accepted 23 August 2009.
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Abstract |
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Background. The Quality and Outcomes Framework (QOF) has contributed to modest improvements in chronic illness care in the UK. US policymakers have proposed similar pay-for-performance (P4P) approaches to improve care. Since previous studies have not compared chronic illness care quality in US and UK primary care practices prior to the QOF, the relative preparedness of practices to respond to P4P incentives is unknown.
Objective. To compare US and UK practices on P4P measures prior to program implementation.
Methods. We analysed medical record data collected before QOF implementation from randomly selected patients with diabetes or coronary artery disease (CAD) in 42 UK and 55 US family medicine practices. We compared care processes and intermediate outcomes using hierarchical logistic regression.
Results. While we found gaps in chronic illness care quality across both samples, variation was lower in UK practices. UK patients were more likely to receive recommended care processes for diabetes [odds ratio (OR), 8.94; 95% confidence interval (CI), 4.26–18.74] and CAD (OR, 9.18; 95% CI, 5.22–16.17) but less likely to achieve intermediate diabetes outcome targets (OR, 0.50; 95% CI, 0.39–0.64).
Conclusions. Following National Health Service (NHS) investment in primary care preparedness, but prior to the QOF, UK practices provided more standardized care but did not achieve better intermediate outcomes than a sample of typical US practices. US policymakers should focus on reducing variation in care documentation to ensure the effectiveness of P4P efforts while the NHS should focus on moving from process documentation to better patient outcomes.
Keywords. Coronary artery disease, diabetes mellitus, health policy, primary health care, quality of health care.
Crosson JC, Ohman-Strickland PA, Campbell S, Phillips RL, Roland MO, Kontopantelis E, Bazemore A, Balasubramanian B and Crabtree BF. A comparison of chronic illness care quality in US and UK family medicine practices prior to pay-for-performance initiatives. Family Practice 2009; 26: 510–516.