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Table 2 Serial cross-sectional studies with measurements both before and after introduction of QOF

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

   

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

   

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

   

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

   

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

  1. 1CHD: Coronary Heart Disease
  2. 2 DM: Diabetes Mellitus
  3. 3CVD: Cerebrovascular Disease
  4. 4BP: Blood Pressure