Programme no. 544-OP
Quality Improvement
Short –term effects of a detailed pay for performance program for diabetes in primary care – an observational study
Helena Ödesjö*1, Staffan Björck2, Jörgen Thorn3
1Enheten för allmänmedicin,Institutionen för medicin,Göteborg,Sweden, 2Avdelningen för molekylär och genetisk medicin,Institutionen för medicin,Göteborg,Sweden, 3Enheten för allmänmedicin,Institutionen för medicin,Göteborg,Sweden
* = Presenting author
Objectives: We assessed effects on registration practice and comparability of data between care givers for patients with diabetes mellitus.
Background: In the County Västra Götaland in Sweden, a pay for performance program was introduced in 200 primary care units for several clinical areas in January 2011. In diabetes mellitus care, it covered 10 quality indicators from the National Diabetes Register (NDR). Six indicators covered quality in reporting and 3 covered proportion of patients reaching targets for HbA1c, blood pressure and LDL-cholesterol. This program replaced payment linked only to registration. Lessons learnt from such interventions are important for design of future reimbursement systems in Primary care.
Results: In VGR, newly recruited patients entered during the incentive program were less well controlled than already known patients in NDR with higher glycated haemoglobin (HbA1c) (54.9 (54.5-55.4) vs 53.7 (53.6-53.9) mmol/mol). Also blood pressure (BP) and LDL cholesterol were higher in new recruited patients. Completeness of data increased in VGR but not in the reference county. In VGR, LDL cholesterol first reported during the incentive program was higher than for patients with annual measurements. In VGR, with an incentive for BP <130/80 mmHg the registration behavior around target was affected with a substantially increased target fulfillment (23.7 vs 28.0 %, p < 0.001).
Material/Methods: Observational study analyzing short term outcomes one year before and one year after introduction of a new payment scheme in primary care in the study county compared with a reference county. The study population consisted of patients from NDR, study county, n = 44 785; reference county, n = 39 268. Variables studied were completeness of data, level and target achievement of glycated haemoglobin (HbA1c), blood pressure (BP) and LDL cholesterol.
Conclusion: Payment for registration led to an altered registration behavior with increased registration, increased completeness of data and an altered BP registration behavior. Newly recruited patients and data were less well controlled than already known patients. Thus, missing patients and missing data in a quality register can lead to overestimation of performance.
Points for discussion: The effect of financial incentives in primary care on registration practice and register data quality.