Pay-for-performance did not improve the quality of care or clinical outcomes for patients with hypertension, according to a new study published online first by BMJ (British Medical Journal).
“We found that the quality of care for hypertension was improving and already close to the threshold set for maximum payment in the pay-for-performance initiative,” wrote the researchers, led by Brian Serumaga, Harvard Medical School Fellow in Pharmaceutical Policy Research, who is from the Division of Primary Care at the University of Nottingham Medical School in Nottingham, England.
“Some performance thresholds may have been set too low for the financial incentive to be effective.” Stephen B. Soumerai, ScD, Professor of Population Medicine at Harvard Medical School, was the senior author.
The researchers examined the impact on hypertension management and outcomes in primary care of a large-scale pay-for-performance policy in England, Scotland, Wales, and Northern Ireland. The policy, which was implemented in April 2004, targeted several chronic conditions, and general practitioners could receive payments as high as 25% of their total income.
Data for the study was taken from The Health Improvement Network (THIN), a database of primary care records from 358 UK general practices. The study sample consisted of 470,725 patients with a diagnosis of hypertension between January 2000 and July 2007.
Changes in several measures were examined at monthly intervals, from three years before the implementation of pay-for-performance to four years after its implementation. These measures included blood pressure monitoring, blood pressure control, treatment intensity, major hypertension-related outcomes, and all-cause mortality. Financial incentives had no effect on any of the measures.
“Effective alternative approaches to improving quality of primary care for hypertension exist, such as case management or comanagement of hypertension and other chronic conditions with allied health professionals such as nurses and pharmacists,” the researchers wrote.
“Furthermore, evidence from studies of educational interventions suggests that fewer, simpler messages are more likely to achieve behavior change than more complex, diffuse messages. Perhaps the resources devoted to pay-for-performance would be better spent on implementing these interventions more widely.”