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Abstract 194: Assessing The Impact Of Financial Incentives On The Quality Of Diabetes Care; An Observational Study Of Primary Care Diabetes Initiatives In Ireland.


 Aim:
 The aim of this study was to examine the association between financial incentives and the quality of structured type 2 diabetes management in three primary care-led initiatives in Ireland.
 
 
 Methods:
 A purposive sample of 3 primary care diabetes initiatives in the Republic of Ireland, were involved in this study. Routine audit data, collected between 2007 and 2009, on 3010 adult patients with Type 2 diabetes across 63 general practices, were analysed. All practices provided structured care to patients with diabetes which involved continuing professional education, maintaining practice registers and engaging in regular audit and feedback. Chi-squared tests were used to examine associations between the presence of financial incentives and the recording of processes of care. Independent t-tests were conducted to examine differences between the groups in terms of intermediate outcomes. Bonferonni adjustment was used to correct for multiple comparisons.
 
 
 Results:
 There were significant differences between practices receiving a financial incentive for participation in a structured care initiative (n=2004), and practices which did not receive financial remuneration (n=1006). While recording of clinical processes of care was high in both groups, recording was significantly higher among practices in receipt of a financial incentive (p=0.000). The level of retinopathy screening and foot assessment received by patients was higher in practices which did not receive financial recompense. However, there was a substantial proportion of missing data for these outcomes in the non-incentivised practices. Over one third of cases had no information on retinopathy screening recorded (35%, 353/1004) and almost two thirds were missing information on the receipt of foot assessment (65%, 651/1004). There was less than 5% missing data for these variables among incentivised practices. Patients in practices receiving a financial incentive had a significantly lower HbA1c value (6.9%) compared to practices not receiving an incentive (7.3%) (p=0.000). There was also a significant difference between the groups in terms of total cholesterol (p=0.000) and diastolic blood pressure (p=0.001). There was no significant difference between the groups in terms of LDL cholesterol (p=0.66), HDL cholesterol levels (p=0.7) or BMI levels (p=0.06).
 
 
 Conclusions:
 This study demonstrates an association between financial remuneration for diabetes management and the quality of care provided to people with diabetes. The results are important given the lack of routine data on the quality of care in Ireland and timely in light of proposed reforms to improve the quality of diabetes care in Ireland, including plans to introduce a national model of integrated care and targeted remuneration for chronic disease management.
