Abstract:
OBJECTIVE:To assess the impact of a pay for performance incentive on quality of care and outcomes among UK patients with hypertension in primary care. DESIGN:Interrupted time series. SETTING:The Health Improvement Network (THIN) database, United Kingdom. PARTICIPANTS:470 725 patients with hypertension diagnosed between January 2000 and August 2007. INTERVENTION:The UK pay for performance incentive (the Quality and Outcomes Framework), which was implemented in April 2004 and included specific targets for general practitioners to show high quality care for patients with hypertension (and other diseases). MAIN OUTCOME MEASURES:Centiles of systolic and diastolic blood pressures over time, rates of blood pressure monitoring, blood pressure control, and treatment intensity at monthly intervals for baseline (48 months) and 36 months after the implementation of pay for performance. Cumulative incidence of major hypertension related outcomes and all cause mortality for subgroups of newly treated (treatment started six months before pay for performance) and treatment experienced (started treatment in year before January 2001) patients to examine different stages of illness. RESULTS:After accounting for secular trends, no changes in blood pressure monitoring (level change 0.85, 95% confidence interval -3.04 to 4.74, P=0.669 and trend change -0.01, -0.24 to 0.21, P=0.615), control (-1.19, -2.06 to 1.09, P=0.109 and -0.01, -0.06 to 0.03, P=0.569), or treatment intensity (0.67, -1.27 to 2.81, P=0.412 and 0.02, -0.23 to 0.19, P=0.706) were attributable to pay for performance. Pay for performance had no effect on the cumulative incidence of stroke, myocardial infarction, renal failure, heart failure, or all cause mortality in both treatment experienced and newly treated subgroups. CONCLUSIONS:Good quality of care for hypertension was stable or improving before pay for performance was introduced. Pay for performance had no discernible effects on processes of care or on hypertension related clinical outcomes. Generous financial incentives, as designed in the UK pay for performance policy, may not be sufficient to improve quality of care and outcomes for hypertension and other common chronic conditions.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Serumaga B,Ross-Degnan D,Avery AJ,Elliott RA,Majumdar SR,Zhang F,Soumerai SBdoi
10.1136/bmj.d108subject
Has Abstractpub_date
2011-01-25 00:00:00pages
d108eissn
0959-8138issn
1756-1833journal_volume
342pub_type
杂志文章abstract:UNLABELLED:OBJECTIVE-To assess the risk of cardiorespiratory symptoms and mortality in non-smokers who were passively exposed to environmental smoke. DESIGN:Prospective study of cohort from general population first screened between 1972 and 1976 and followed up for an average of 11.5 years, with linkage of data from p...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
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更新日期:1989-08-12 00:00:00
abstract:OBJECTIVES:To assess timeliness of carotid endarterectomy services in the United Kingdom. DESIGN:Observational study with follow-up to March 2008. SETTING:UK hospitals performing carotid endarterectomy. PARTICIPANTS:UK surgeons undertaking carotid endarterectomy from December 2005 to December 2007. MAIN OUTCOME MEA...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
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journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
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更新日期:2020-06-16 00:00:00
abstract:OBJECTIVE:To evaluate the outcome of liver transplantation in patients with alcoholic cirrhosis with respect to selection criteria, survival, and evidence suggesting a return to harmful drinking. DESIGN:Nine year retrospective study. SETTING:Cambridge and King's College Hospital liver transplant programme. SUBJECTS:...
journal_title:BMJ (Clinical research ed.)
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abstract:OBJECTIVE:To assess the risk of adverse perinatal events of vaccination of pregnant women with an MF59 adjuvanted vaccine. DESIGN:Cross sectional multicentre study. SETTING:49 public hospitals in major cities in Argentina, from September 2010 to May 2011. PARTICIPANTS:30,448 mothers (7293 vaccinated) and their 30,76...
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pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:BMJ (Clinical research ed.)
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更新日期:2012-10-31 00:00:00
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更新日期:2005-11-19 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2009-05-22 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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pub_type: 杂志文章
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更新日期:1994-07-02 00:00:00
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更新日期:2019-05-29 00:00:00
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更新日期:2013-11-12 00:00:00
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pub_type: 新闻
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更新日期:1989-04-15 00:00:00
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更新日期:1996-05-25 00:00:00
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更新日期:1997-01-25 00:00:00
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更新日期:2002-03-16 00:00:00
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更新日期:2015-07-28 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2002-06-29 00:00:00
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更新日期:2010-12-09 00:00:00
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更新日期:1990-07-14 00:00:00