From: The equity dimension in evaluations of the quality and outcomes framework: A systematic review
Study | Study design | Condition/Indicator | Cross sectional analysis after introduction of the Quality and Outcomes Framework |
---|---|---|---|
Deprivation | Â | Â | Â |
Millet 2007. Impact of a pay-for performance incentive on support for smoking cessation among people with diabetes | Longitudinal Repeated measurements Pre- and post contract 2003 and 2005 Effects of deprivation studied adjusting for age, sex, ethnic background and practice level clustering. | Diabetes recorded smoking status Smoking cessation advice smoking prevalence | Recorded smoking status: No gap documented post contract Recorded smoking status: No gap documented post contract Smoking: No gap documented post contract |
Millet 2008c. Impact of a pay for performance on ethnic disparities in intermediate outcomes for diabetes: longitudinal study | Longitudinal repeated measurements Pre- and post contract 2000 and 2005-2006 | Diabetes HbA1c & BP measured HbA1c & BP levels | Change in BP levels: indifferent for neigbourhood deprivation Change in HbA1c level: indifferent for neigbourhood deprivation |
Mc Govern 2008b. The effect of the UK incentive based contract on the management of patients with coronary heart disease in primary care | Serial cross sectional Pre and post contract 2000 and 2005 | CHD1 11 indicators | Increasing gap from 1/11 to 4/11 CHD indicators pro less deprived. |
McGovern 2008 Introduction of a new incentive and target based contract for family physicians in the UK: good for older patients with diabetes but less good for women | Serial cross sectional Pre and post contract 2000 and 2005 | DM2 8 indicators | Decreasing gap from 2/8 to 1/8 DM indicators pro less deprived |
Simpson 2006. Effect of the UK incentive based contract on the management of patients with stroke in primary care | Serial cross sectional Pre and post contract 2004 and 2005 | CVD3 9 indicators | Increasing gap from 1/9 to 3/9 CVG indicators pro less deprived |
Crawley 2009. Impact of pay for performance on quality of chronic disease management by social class group in England | Serial cross sectional Pre contract 2003 Post contract 2006 | CHD - BP achievement - Use of antihypertensives - Cholesterol achievement - Use of lipid lowering drugs Diabetes - BP achievement - Use of antihypertensives - Cholesterol achievement - Use of lipid lowering drugs - Hba1c achievement - Use of oral hypoglycaemic agents Hypertension - BP achievement - Use of antihypertensives | Emerging gap pro non-manual occupations No gap documented No gap documented No gap documented No gap documented No gap documented No gap documented No gap documented Decreasing gap to a non significant difference pro non-manual occupations No gap documented No gap documented No gap documented |
Ashworth 2008. Effect of social deprivation on blood pressure monitoring and control in England: a survey of data from the quality and outcomes framework | Serial cross sectional Post contract 2004-2005; 2005-2006 and 2006-2007 | 5 chronic conditions BP4 monitoring BP target values | BP monitoring: gap narrowed to a negligible difference (0.2% between most and least deprived areas) Achieving BP target value: gap narrowed to a small but significant residual difference pro less deprived but for DM a small inverse gap occured |
Ashworth 2007a. The relationship between social deprivation and the quality of primary care: a national survey using the indicators from the UK quality and outcomes framework | Serial cross sectional Post contract 2004-2005 and 2005-2006 | Total QOF score 147 indicators | Decreasing gap to a small but significant residual difference 2 years after introduction of QOF pro less deprived |
Doran 2008a. Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework | Serial cross sectional Post contract 2004-2005; 2005-2006 and 2006-2007 | 48 clinical activity indicators | Decreasing gap to a small but significant residual difference 3 years after introduction of QOF pro less deprived |
Ethnicity | Â | Â | Â |
Millet 2007b. Impact of a pay-for-performance incentive on support for smoking cessation and on smoking prevalence among people with diabetes | Longitudinal repeated measurements Pre- and post contract 2003 and 2005 Effects of ethnicity studied adjusting for age, sex, deprivation and practice level clustering. | Diabetes recorded smoking status smoking cessation advice smoking prevalence | Recorded smoking status: Increasing gap pro ethnic minorities Smoking cessation advice: Gap disappeared post contract Smoking: Decreasing gap remaining pro whites |
Millet 2008c. Impact of pay for performance on ethnic disparities in intermediate outcomes for diabetes: longitudinal study | Longitudinal Repeated measurements Pre- and post contract 2000 and 2005-2006 | Diabetes HbA1c measurement BP measurement | HbA1c& BP measurement: no gap documented post contract Achievement of BP levels Increasing gap pro Whites and South Asians Achievement HbA1c levels Increasing gap pro Whites |
Millet 2007a Ethnic disparities in diabetes management and pay for performance in the UK: The Wandsworth prospective diabetes study | Longitudinal Repeated measurements Pre- and post contract 2003-2004 and 2005-2006 Effects of ethnicity studied adjusting for age, sex, deprivation and practice level clustering. | Diabetes/Hyperglycemia management & control Hyperlipidemia management & control Hypertension Management & Control | Achievement HbA1c target: Increasing gap pro whites Prescription OHA: Increasing gap pro ethnic minorities Prescription insulin Increasing gap pro whites Achievement cholesterol target Decreasing gap remaining pro ethnic minorities Prescription Lipid lowering drugs Gap Whites vs Black Caribeans disappeared Gap Whites vs Black Africans decreased remaining pro whites Gap Whites vs Bangladeshi occurred (pro Bangladeshi) Achievement BP target Increasing gap pro whites Prescription ACE inhibitors No gap documented post contract |
Millet 2008b. Ethnic disparities in coronary heart disease management and pay for performance in the UK | Serial cross sectional Pre and post contract 2003 and 2005 | CHD 10 indicators | Decreasing gap remaining pro whites Gap Asians vs Whites occurs pro Asians |
Ashworth 2008. Effect of social deprivation on blood pressure monitoring and control in England: analysis of clinical activity indicators for the quality and outcomes framework | Serial cross sectional Post contract 2004-2005; 2005-2006 and 2006-2007 | 5 chronic conditions Blood pressure monitoring | Gap between least and most deprived areas narrowed to a negligible difference, with the proportion of ethnic minorities having the strongest confounding effect on BP monitoring |
Age | Â | Â | Â |
Millet 2008c. Impact of pay for performance on ethnic disparities in intermediate outcomes for diabetes: longitudinal study | Longitudinal Repeated measurements Pre- and post contract 2000 and 2005-2006 | Diabetes HbA1c measured BP measured | Change in BP level: pro young Change in HbA1c level: pro old |
Millet 2007b. Impact of a pay for performance incentive on support for smoking cessation and on smoking prevalence among people with diabetes. | Longitudinal Repeated measurements Pre- and post contract 2003 and 2005 Effects of age studied adjusting for sex, deprivation, ethnic background and practice level clustering. | Diabetes/recorded smoking status, smoking sessation advice, smoking prevalence | Recorded smoking status: gap disappears Smoking cessation advice: gap disappears Smoking: decreasing gap remaining pro pro old |
McGovern 2008b. The effect of the UK incentive based contract on the management of patients with stroke in primary care | Serial cross sectional Pre and post contract 2000 and 2005 | CHD 11 indicators | Decreasing gap from 9/11 to 7/11 CHD indicators |
McGovern 2008. Introduction of a new incentive and target based contract for family physicians in the UK: good for older patients with diabetes but less good for women. | Serial cross sectional Pre and post contract 2000 and 2005 | DM 8 indicators | Gap pro younger decreased (5/8 to 1/8 indicators pro young) Gap pro older increased (2/8 to 4/8 indicators pro old) |
Simpson 2006. Effect of the UK incentive based contract on the management of patients with stroke in primary care. | Serial cross sectional Pre and post contract 2004 and 2005 | CVD 9 indicators | Gap pro younger decreased (6/9 to 4/9 indicators pro young) Gap pro older increased (1/9 to 2/9 indicators pro old) |
Sex | Â | Â | Â |
Millet 2008c. Impact of pay for performance on ethnic disparities in intermediate outcomes for diabetes: longitudinal study | Longitudinal Repeated measurements Pre- and post contract 2000 and 2005-2006 | Diabetes HbA1measured BP measured | Change in diastolic BP level: pro men Change in HbA1c level: pro women |
Millet 2007b. Impact of a pay for performance incentive on support for smoking cessation and on smoking prevalence among people with diabetes. | Longitudinal Repeated measurements Pre- and post contract 2003 and 2005 Effects of sex studied adjusting for age, deprivation, ethnic background and practice level clustering. | Diabetes recorded smoking status smoking cessation advice smoking prevalence | Recorded smoking status: Decreasing gap Smoking sessation advice: No gap documented Smoking: Decreasing gap |
McGovern 2008b. The effect of the UK incentive based contract on the management of patients with stroke in primary care | Serial cross sectional Pre and post contract 2000 and 2005 | CHD 11 indicators | Increasing gap from 7/11 to 9/11 CHD indicators pro men |
McGovern 2008. Introduction of a new incentive and target based contract for family physicians in the UK: good for older patients with diabetes but less good for women. | Serial cross sectional Pre and post contract 2000 and 2005 | DM 8 indicators | Increasing gap from 2/8 to 5/8 DM indicators pro men |
Simpson 2006. Effect of the UK incentive based contract on the management of patients with stroke in primary care. | Serial cross sectional Pre and post contract 2004 and 2005 | CVD 9 indicators | Decreasing gap from 7/9 to 5/9 CVD indicators pro men |