Exclusion of patients from quality measurement of diabetes care in the UK pay-for-performance programme.

Background: We examined associations between patient and practice characteristics and exclusions fromquality indicators for diabetes during the first 3 years of the Quality and Outcomes Framework, a major pay-for-performance scheme in the UK. Methods: Three cross-sectional analyses, conducted using data from the electronicmedical records of all patients with diabetes registered in 23 general practices in Brent, NorthWestLondon between 2004 ⁄ 2005 and 2006 ⁄ 2007. Patterns of exclusionswere examined for three intermediate outcome indicators. Results: Excluded patients were less likely to achieve treatment targets for HbA1c (2004 ⁄ 2005, 2006 ⁄ 2007), blood pressure (2005 ⁄ 2006, 2006 ⁄ 2007) and cholesterol (2005 ⁄ 2006). Black and South Asian patients were more likely to be excluded from the HbA1c indicator than White patients [adjusted odds ratio = 1.64 (1.17-2.29) in 2005 ⁄ 2006]. Patients diagnosed with diabetes duration of > 10 years [adjusted odds ratio = 2.01 (1.65-2.45) forHbA1c in2006-2007] andthosewith co-morbidities (adjusted odds ratio, ‡ 3 co-morbidities compared with no co-morbidity for HbA1c adjusted odds ratio = 1.90 (1.24-2.90) in 2004⁄ 2005] were more likely to be excluded. Larger practices excluded more patients from theHbA1c indicator [adjusted odds ratio, practice ‡ 7000 comparedwith < 3000, 3.52 (2.35-5.27) in 2005-2006].More deprived practices consistently excluded more patients from all indicators, whilst in 2007 older patients were excluded to a larger degree [adjusted odds ratio = 2.52 (1.21-5.28) ‡ 75 compared with 18-44 for blood pressure control]. Conclusions: Patients excluded from pay-for performance programmes may be less likely to achieve treatment goals and disproportionately come from disadvantaged groups. Permitting physicians to exclude patients from pay for-performance programmes may worsen health disparities. [ABSTRACT FROM AUTHOR]