A comparison of chronic illness care quality in US and UK family medicine practices prior to pay-for-performance initiatives

Jesse C. Crosson, Pamela A. Ohman-Strickland, Stephen Campbell, Robert L. Phillips, Martin O. Roland, Evangelos Kontopantelis, Andrew Bazemore, Bijal Balasubramanian, Benjamin F. Crabtree

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background. The Quality and Outcomes Framework (QOF) has contributed to modest improvements in chronic illness care in the UK. US policymakers have proposed similar pay-for-performance (P4P) approaches to improve care. Since previous studies have not compared chronic illness care quality in US and UK primary care practices prior to the QOF, the relative preparedness of practices to respond to P4P incentives is unknown. Objective. To compare US and UK practices on P4P measures prior to program implementation. Methods. We analysed medical record data collected before QOF implementation from randomly selected patients with diabetes or coronary artery disease (CAD) in 42 UK and 55 US family medicine practices. We compared care processes and intermediate outcomes using hierarchical logistic regression. Results. While we found gaps in chronic illness care quality across both samples, variation was lower in UK practices. UK patients were more likely to receive recommended care processes for diabetes [odds ratio (OR), 8.94; 95% confidence interval (CI), 4.26-18.74] and CAD (OR, 9.18; 95% CI, 5.22-16.17) but less likely to achieve intermediate diabetes outcome targets (OR, 0.50; 95% CI, 0.39-0.64). Conclusions. Following National Health Service (NHS) investment in primary care preparedness, but prior to the QOF, UK practices provided more standardized care but did not achieve better intermediate outcomes than a sample of typical US practices. US policymakers should focus on reducing variation in care documentation to ensure the effectiveness of P4P efforts while the NHS should focus on moving from process documentation to better patient outcomes.

Original languageEnglish (US)
Pages (from-to)510-516
Number of pages7
JournalFamily practice
Issue number6
StatePublished - 2009

All Science Journal Classification (ASJC) codes

  • Family Practice


  • Coronary artery disease
  • Diabetes mellitus
  • Health policy
  • Primary health care
  • Quality of health care

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