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(Hypertension. 2009;54:e5.)
© 2009 American Heart Association, Inc.

Letters to the Editor

Implementation of Pay for Performance Policy in England

Department of Epidemiology and Public Health, University College of London, London, United Kingdom

Norm R.C. Campbell; Sailesh Mohan

Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada

Neil Poulter

International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

Our recent article¹ and editorial² address changes in hypertension awareness, treatment, and control in England. In the editorial,² Drs Mohan and Campbell reported that the annual changes in rates of awareness, treatment, and control appear to be slightly lower after implementation of "pay for performance" (PFP) compared with corresponding rates before PFP. However, these estimates did not take into account that, in 2003, a new automated device, the Omron HEM 907, was introduced to measure blood pressure, as a replacement for the Dinamap 8100, which had been used in previous Health Survey for England surveys but had become obsolete.³ To allow comparisons of 2003 with previous years, a calibration study was carried out to provide suitable regression equations to derive predicted Omron readings from Dinamap readings.⁴ In addition, in 2003 and 2006, samples were weighted to allow for nonresponse differences, whereas previous samples were not weighted. So, in comparisons among 1994, 1998, and 2003, we used unweighted predicted Omron readings for 1994 and 1998 and unweighted real OMRON readings for 2003, as previously published.⁴ For comparisons between 2003 and 2006 we used weighted OMRON readings. Using these data, the rates of change can be reasonably compared (Table). Overall, the annual change in rate of awareness was marginally lower after implementation of PFP compared with before PFP, but the annual change in the rate of control tended to be higher after PFP than before. Interestingly, the annual changes in rates of awareness, treatment, and control after . . . [Full Text of this Article]