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{"title"=>"Ethnic disparities in diabetes management and pay-for-performance in the UK: The Wandsworth prospective diabetes study", "type"=>"journal", "authors"=>[{"first_name"=>"Christopher", "last_name"=>"Millett", "scopus_author_id"=>"8610765600"}, {"first_name"=>"Jeremy", "last_name"=>"Gray", "scopus_author_id"=>"7404300087"}, {"first_name"=>"Sonia", "last_name"=>"Saxena", "scopus_author_id"=>"56471208600"}, {"first_name"=>"Gopalakrishnan", "last_name"=>"Netuveli", "scopus_author_id"=>"9233259300"}, {"first_name"=>"Kamlesh", "last_name"=>"Khunti", "scopus_author_id"=>"7005202765"}, {"first_name"=>"Azeem", "last_name"=>"Majeed", "scopus_author_id"=>"7102027801"}], "year"=>2007, "source"=>"PLoS Medicine", "identifiers"=>{"issn"=>"15491277", "isbn"=>"1549-1676 (Electronic)\\r1549-1277 (Linking)", "pui"=>"46998625", "sgr"=>"34347235863", "doi"=>"10.1371/journal.pmed.0040191", "scopus"=>"2-s2.0-34347235863", "pmid"=>"17564486"}, "id"=>"66cce1f7-457a-3d4d-b241-5b70479d8154", "abstract"=>"BACKGROUND: Pay-for-performance rewards health-care providers by paying them more if they succeed in meeting performance targets. A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay-for-performance seen in any health-care system. The contract provides an important opportunity to address disparities in chronic disease management between ethnic and socioeconomic groups. We examined disparities in management of people with diabetes and intermediate clinical outcomes within a multiethnic population in primary care before and after the introduction of the new contract in April 2004. METHODS AND FINDINGS: We conducted a population-based longitudinal survey, using electronic general practice records, in an ethnically diverse part of southwest London. Outcome measures were prescribing levels and achievement of national treatment targets (HbA1c < or = 7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol < or = 5 mmol/l or 193 mg/dl). The proportion of patients reaching treatment targets for HbA1c, BP, and total cholesterol increased significantly after the implementation of the new contract. The extents of these increases were broadly uniform across ethnic groups, with the exception of the black Caribbean patient group, which had a significantly lower improvement in HbA1c (adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.57-0.97) and BP control (AOR 0.65, 95% CI 0.53-0.81) relative to the white British patient group. Variations in prescribing and achievement of treatment targets between ethnic groups present in 2003 were not attenuated in 2005. CONCLUSIONS: Pay-for-performance incentives have not addressed disparities in the management and control of diabetes between ethnic groups. Quality improvement initiatives must place greater emphasis on minority communities to avoid continued disparities in mortality from cardiovascular disease and the other major complications of diabetes.", "link"=>"http://www.mendeley.com/research/ethnic-disparities-diabetes-management-payforperformance-uk-wandsworth-prospective-diabetes-study", "reader_count"=>128, "reader_count_by_academic_status"=>{"Unspecified"=>2, "Professor > Associate Professor"=>8, "Librarian"=>2, "Researcher"=>25, "Student > Doctoral Student"=>4, "Student > Ph. D. Student"=>26, "Student > Postgraduate"=>4, "Other"=>18, "Student > Master"=>18, "Student > Bachelor"=>9, "Lecturer"=>3, "Lecturer > Senior Lecturer"=>2, "Professor"=>7}, "reader_count_by_user_role"=>{"Unspecified"=>2, "Professor > Associate Professor"=>8, "Librarian"=>2, "Researcher"=>25, "Student > Doctoral Student"=>4, "Student > Ph. D. Student"=>26, "Student > Postgraduate"=>4, "Other"=>18, "Student > Master"=>18, "Student > Bachelor"=>9, "Lecturer"=>3, "Lecturer > Senior Lecturer"=>2, "Professor"=>7}, "reader_count_by_subject_area"=>{"Unspecified"=>6, "Nursing and Health Professions"=>8, "Materials Science"=>1, "Agricultural and Biological Sciences"=>5, "Medicine and Dentistry"=>68, "Arts and Humanities"=>2, "Business, Management and Accounting"=>6, "Pharmacology, Toxicology and Pharmaceutical Science"=>2, "Psychology"=>2, "Social Sciences"=>20, "Computer Science"=>2, "Economics, Econometrics and Finance"=>6}, "reader_count_by_subdiscipline"=>{"Materials Science"=>{"Materials Science"=>1}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>68}, "Social Sciences"=>{"Social Sciences"=>20}, "Psychology"=>{"Psychology"=>2}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>6}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>5}, "Computer Science"=>{"Computer Science"=>2}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>8}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>6}, "Unspecified"=>{"Unspecified"=>6}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>2}, "Arts and Humanities"=>{"Arts and Humanities"=>2}}, "reader_count_by_country"=>{"Republic of Singapore"=>1, "Colombia"=>1, "Canada"=>1, "Bangladesh"=>1, "Belgium"=>1, "United States"=>2, "United Kingdom"=>4, "Portugal"=>2, "India"=>2, "Indonesia"=>1}, "group_count"=>13}

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Figshare

• {"files"=>["https://ndownloader.figshare.com/files/467250"], "description"=>"<div><h3>Background</h3><p>Pay-for-performance rewards health-care providers by paying them more if they succeed in meeting performance targets. A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay-for-performance seen in any health-care system. The contract provides an important opportunity to address disparities in chronic disease management between ethnic and socioeconomic groups. We examined disparities in management of people with diabetes and intermediate clinical outcomes within a multiethnic population in primary care before and after the introduction of the new contract in April 2004.</p> <h3>Methods and Findings</h3><p>We conducted a population-based longitudinal survey, using electronic general practice records, in an ethnically diverse part of southwest London. Outcome measures were prescribing levels and achievement of national treatment targets (HbA_1c ≤ 7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol ≤ 5 mmol/l or 193 mg/dl). The proportion of patients reaching treatment targets for HbA_1c, BP, and total cholesterol increased significantly after the implementation of the new contract. The extents of these increases were broadly uniform across ethnic groups, with the exception of the black Caribbean patient group, which had a significantly lower improvement in HbA_1c (adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.57–0.97) and BP control (AOR 0.65, 95% CI 0.53–0.81) relative to the white British patient group. Variations in prescribing and achievement of treatment targets between ethnic groups present in 2003 were not attenuated in 2005.</p> <h3>Conclusions</h3><p>Pay-for-performance incentives have not addressed disparities in the management and control of diabetes between ethnic groups. Quality improvement initiatives must place greater emphasis on minority communities to avoid continued disparities in mortality from cardiovascular disease and the other major complications of diabetes.</p> </div>", "links"=>[], "tags"=>["disparities", "pay-for-performance", "wandsworth", "prospective"], "article_id"=>152121, "categories"=>["Chemistry", "Medicine", "Biotechnology"], "users"=>["Christopher Millett", "Jeremy Gray", "Sonia Saxena", "Gopalakrishnan Netuveli", "Kamlesh Khunti", "Azeem Majeed"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.0040191", "stats"=>{"downloads"=>3, "page_views"=>32, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Ethnic_Disparities_in_Diabetes_Management_and_Pay_for_Performance_in_the_UK_The_Wandsworth_Prospective_Diabetes_Study/152121", "title"=>"Ethnic Disparities in Diabetes Management and Pay-for-Performance in the UK: The Wandsworth Prospective Diabetes Study", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2007-06-12 00:35:21"}

PMC Usage Stats | Further Information

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Relative Metric

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F1000Prime