Brian Serumaga, Dennis Ross-Degnan, Anthony J. Avery, Rachel A. Elliott, Sumit R. Majumdar, Fang Zhang, and Stephen B. Soumerai
B. Serumaga, D. Ross-Degnan, A. J. Avery et al., "Effect of Pay for Performance on the Management and Outcomes of Hypertension in the United Kingdom: Interrupted Time Series Study," BMJ, Jan. 25, 2011 342.
The impact of pay-for-performance programs on the quality of care for chronic conditions, and the outcomes of that care, is largely unknown, though such programs are increasingly common. Commonwealth Fund–supported researchers examined how a large-scale pay-for-performance program in the United Kingdom affected management and outcomes for one such condition—hypertension.
Based on review of data for 470,725 patients with hypertension, researchers found that there were no changes in blood-pressure monitoring, control, or treatment intensity 36 months after implementation of the payment incentives. In terms of outcomes, the incentives had no effect on the incidence of stroke, myocardial infarction, renal failure, heart failure, or all-cause mortality rates.
The authors note that the quality of care for hypertension had been increasing in the U.K. prior to implementation of this program and suggest that the performance targets may have been insufficiently ambitious. They conclude that, based on the U.K. experience, "generous financial incentives…may not be sufficient to improve quality of care and outcomes for hypertension and other common chronic conditions."