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Research article:

Recorded quality of primary care for patients with diabetes in England before and after the introduction of a financial incentive scheme: a longitudinal observational study

Reference:

Evangelos Kontopantelis; David Reeves; Jose M Valderas; Stephen Campbell; Tim Doran (2012) Recorded quality of primary care for patients with diabetes in England before and after the introduction of a financial incentive scheme: a longitudinal observational study. BMJ Quality and Safety, doi: 10.1136/bmjqs-2012-001033

Link to article
Abstract
Background: The UK's Quality and Outcomes Framework (QOF) was introduced in 2004/5, linking remuneration for general practices to recorded quality of care for chronic conditions, including diabetes mellitus. We assessed the effect of the incentives on recorded quality of care for diabetes patients and its variation by patient and practice characteristics. Methods: Using the General Practice Research Database we selected a stratified sample of 148 English general practices in England, contributing data from 2000/1 to 2006/7, and obtained a random sample of 653 500 patients in which 23 920 diabetes patients identified. We quantified annually recorded quality of care at the patient-level, as measured by the 17 QOF diabetes indicators, in a composite score and analysed it longitudinally using an Interrupted Time Series design. Results: Recorded quality of care improved for all subgroups in the pre-incentive period. In the first year of the incentives, composite quality improved over-and-above this pre-incentive trend by 14.2% (13.7–14.6%). By the third year the improvement above trend was smaller, but still statistically significant, at 7.3% (6.7–8.0%). After 3 years of the incentives, recorded levels of care varied significantly for patient gender, age, years of previous care, number of co-morbid conditions and practice diabetes prevalence. Conclusions: The introduction of financial incentives was associated with improvements in the recorded quality of diabetes care in the first year. These improvements included some measures of disease control, but most captured only documentation of recommended aspects of clinical assessment, not patient management or outcomes of care. Improvements in subsequent years were more modest. Variation in care between population groups diminished under the incentives, but remained substantial in some cases.
Author for correspondence
Evangelos Kontopantelis
Email for correspondence
e.kontopantelis@manchester.ac.uk

Code list: res43: asthma_kontopantelis_bmjqs2012

197 codes in list

Code Coding system Description Entity type List name qof code conservative resolve
173A.00 Read Exercise induced asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
173c.00 Read Occupational asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
173d.00 Read Work aggravated asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
178..00 Read Asthma trigger diagnostic res43: asthma_kontopantelis_bmjqs2012 no
1780.00 Read Aspirin induced asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
1O2..00 Read Asthma confirmed diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
2126200 Read Asthma resolved diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
212G.00 Read Asthma resolved diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
663..11 Read Asthma monitoring test res43: asthma_kontopantelis_bmjqs2012 no
663d.00 Read Emergency asthma admission since last appointment symptom res43: asthma_kontopantelis_bmjqs2012 no
663e.00 Read Asthma restricts exercise symptom res43: asthma_kontopantelis_bmjqs2012 no
663e000 Read Asthma sometimes restricts exercise symptom res43: asthma_kontopantelis_bmjqs2012 no
663e100 Read Asthma severely restricts exercise symptom res43: asthma_kontopantelis_bmjqs2012 no
663f.00 Read Asthma never restricts exercise symptom res43: asthma_kontopantelis_bmjqs2012 no
663h.00 Read Asthma - currently dormant diagnostic res43: asthma_kontopantelis_bmjqs2012 no
663j.00 Read Asthma - currently active diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
663m.00 Read Asthma accident and emergency attendance since last visit symptom res43: asthma_kontopantelis_bmjqs2012 no
663n.00 Read Asthma treatment compliance satisfactory drug res43: asthma_kontopantelis_bmjqs2012 no
663N.00 Read Asthma disturbing sleep symptom res43: asthma_kontopantelis_bmjqs2012 no
663N000 Read Asthma causing night waking symptom res43: asthma_kontopantelis_bmjqs2012 no
663N100 Read Asthma disturbs sleep weekly symptom res43: asthma_kontopantelis_bmjqs2012 no
663N200 Read Asthma disturbs sleep frequently symptom res43: asthma_kontopantelis_bmjqs2012 no
663O.00 Read Asthma not disturbing sleep symptom res43: asthma_kontopantelis_bmjqs2012 no
663O000 Read Asthma never disturbs sleep symptom res43: asthma_kontopantelis_bmjqs2012 no
663p.00 Read Asthma treatment compliance unsatisfactory drug res43: asthma_kontopantelis_bmjqs2012 no
663P.00 Read Asthma limiting activities symptom res43: asthma_kontopantelis_bmjqs2012 no
663q.00 Read Asthma daytime symptoms diagnostic res43: asthma_kontopantelis_bmjqs2012 no
663Q.00 Read Asthma not limiting activities symptom res43: asthma_kontopantelis_bmjqs2012 no
663r.00 Read Asthma causes night symptoms 1 to 2 times per month diagnostic res43: asthma_kontopantelis_bmjqs2012 no
663s.00 Read Asthma never causes daytime symptoms diagnostic res43: asthma_kontopantelis_bmjqs2012 no
663t.00 Read Asthma causes daytime symptoms 1 to 2 times per month diagnostic res43: asthma_kontopantelis_bmjqs2012 no
663u.00 Read Asthma causes daytime symptoms 1 to 2 times per week diagnostic res43: asthma_kontopantelis_bmjqs2012 no
663U.00 Read Asthma management plan given test res43: asthma_kontopantelis_bmjqs2012 no
663v.00 Read Asthma causes daytime symptoms most days diagnostic res43: asthma_kontopantelis_bmjqs2012 no
663V.00 Read Asthma severity test res43: asthma_kontopantelis_bmjqs2012 no
663V000 Read Occasional asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
663V100 Read Mild asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
663V200 Read Moderate asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
663V300 Read Severe asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
663w.00 Read Asthma limits walking up hills or stairs symptom res43: asthma_kontopantelis_bmjqs2012 no
663W.00 Read Asthma prophylactic medication used drug res43: asthma_kontopantelis_bmjqs2012 no
663x.00 Read Asthma limits walking on the flat symptom res43: asthma_kontopantelis_bmjqs2012 no
663y.00 Read Number of asthma exacerbations in past year diagnostic res43: asthma_kontopantelis_bmjqs2012 no
66Y5.00 Read Change in asthma management plan test res43: asthma_kontopantelis_bmjqs2012 no
66Y9.00 Read Step up change in asthma management plan test res43: asthma_kontopantelis_bmjqs2012 no
66YA.00 Read Step down change in asthma management plan test res43: asthma_kontopantelis_bmjqs2012 no
66YC.00 Read Absent from work or school due to asthma symptom res43: asthma_kontopantelis_bmjqs2012 no
66YJ.00 Read Asthma annual review test res43: asthma_kontopantelis_bmjqs2012 no
66YK.00 Read Asthma follow-up test res43: asthma_kontopantelis_bmjqs2012 no
66YP.00 Read Asthma night-time symptoms diagnostic res43: asthma_kontopantelis_bmjqs2012 no
66YQ.00 Read Asthma monitoring by nurse test res43: asthma_kontopantelis_bmjqs2012 no
66YR.00 Read Asthma monitoring by doctor test res43: asthma_kontopantelis_bmjqs2012 no
8791.00 Read Further asthma - drug prevent. drug res43: asthma_kontopantelis_bmjqs2012 no
8793.00 Read Asthma control step 0 test res43: asthma_kontopantelis_bmjqs2012 no
8794.00 Read Asthma control step 1 test res43: asthma_kontopantelis_bmjqs2012 no
8795.00 Read Asthma control step 2 test res43: asthma_kontopantelis_bmjqs2012 no
8796.00 Read Asthma control step 3 test res43: asthma_kontopantelis_bmjqs2012 no
8797.00 Read Asthma control step 4 test res43: asthma_kontopantelis_bmjqs2012 no
8798.00 Read Asthma control step 5 test res43: asthma_kontopantelis_bmjqs2012 no
8B3j.00 Read Asthma medication review drug res43: asthma_kontopantelis_bmjqs2012 no
8CR0.00 Read Asthma clinical management plan test res43: asthma_kontopantelis_bmjqs2012 no
8H2P.00 Read Emergency admission, asthma test res43: asthma_kontopantelis_bmjqs2012 no
8HTT.00 Read Referral to asthma clinic test res43: asthma_kontopantelis_bmjqs2012 no
9N1d.00 Read Seen in asthma clinic test res43: asthma_kontopantelis_bmjqs2012 no
9NI8.00 Read Asthma outreach clinic test res43: asthma_kontopantelis_bmjqs2012 no
9OJ1.00 Read Attends asthma monitoring test res43: asthma_kontopantelis_bmjqs2012 no
9OJA.00 Read Asthma monitoring check done test res43: asthma_kontopantelis_bmjqs2012 no
9OJA.11 Read Asthma monitored test res43: asthma_kontopantelis_bmjqs2012 no
c109.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c11b.00 Read VENTOLIN sf syrp 2mg/5ml drug res43: asthma_kontopantelis_bmjqs2012 yes no
c11z.00 Read Other disorder of pancreatic internal secretion NOS drug res43: asthma_kontopantelis_bmjqs2012 yes no
c135.00 Read Diabetes insipidus drug res43: asthma_kontopantelis_bmjqs2012 yes no
c13G.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c13I.00 Read AIROMIR cfc free inh 100micrograms/inhalation drug res43: asthma_kontopantelis_bmjqs2012 yes no
c13J.00 Read SALBUTAMOL cfc free inh 100micrograms/inhalation drug res43: asthma_kontopantelis_bmjqs2012 yes no
c13L.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c13o.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c13T.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c13U.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c13v.00 Read SALBUTAMOL inh 100micrograms/inhalation drug res43: asthma_kontopantelis_bmjqs2012 yes no
c13w.00 Read SALBUTAMOL unit dose neb soln 2.5mg/2.5ml drug res43: asthma_kontopantelis_bmjqs2012 yes no
c14f.00 Read BRICANYL TURBOHALER 500micrograms drug res43: asthma_kontopantelis_bmjqs2012 yes no
c14j.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c14w.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c191.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c192.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c198.00 Read SEREVENT ACCUHALER 50micrograms/actuation drug res43: asthma_kontopantelis_bmjqs2012 yes no
c1C4.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c1D6.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c1Du.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c1Dv.00 Read SALMETEROL + FLUTICASONE cfc free inh 25micrograms + 125micrograms/actuation drug res43: asthma_kontopantelis_bmjqs2012 yes no
c1Dw.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c1Dz.00 Read SALMETEROL + FLUTICASONE dry pdr inh 50micrograms+ 500micrograms/inhalation drug res43: asthma_kontopantelis_bmjqs2012 yes no
c1E1.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c1E7.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c315.00 Read ATROVENT AUTOHALER breath act inh 20micrograms/actuation drug res43: asthma_kontopantelis_bmjqs2012 yes no
c31G.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c31t.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c31u.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c31x.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c332.00 Read Other paraproteinaemias drug res43: asthma_kontopantelis_bmjqs2012 yes no
c617.00 Read BECOTIDE 100 inh 100micrograms/actuation drug res43: asthma_kontopantelis_bmjqs2012 yes no
c61F.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c61i.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c61O.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c61t.00 Read BECLOMETASONE inh 250micrograms/actuation drug res43: asthma_kontopantelis_bmjqs2012 yes no
c61u.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c61v.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c61x.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c61z.00 Read BECLOMETASONE inh 100micrograms/actuation drug res43: asthma_kontopantelis_bmjqs2012 yes no
c648.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c65f.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c65V.00 Read FLIXOTIDE ACCUHALER 250micrograms/inhalation drug res43: asthma_kontopantelis_bmjqs2012 yes no
c663.00 Read BECOTIDE EASI-BREATHE breath act inh 100micrograms/actuation drug res43: asthma_kontopantelis_bmjqs2012 yes no
c665.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c66a.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c66B.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
c672.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
cA11.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
cA15.00 Read drug res43: asthma_kontopantelis_bmjqs2012 yes no
H312000 Read Chronic asthmatic bronchitis diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
H33..00 Read Asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H330.00 Read Extrinsic (atopic) asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H330000 Read Extrinsic asthma without status asthmaticus diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H330011 Read Hay fever with asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H330100 Read Extrinsic asthma with status asthmaticus diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H330.11 Read Allergic asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H330111 Read Extrinsic asthma with asthma attack diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H330.12 Read Childhood asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H330.13 Read Hay fever with asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H330.14 Read Pollen asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H330z00 Read Extrinsic asthma NOS diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H331.00 Read Intrinsic asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H331000 Read Intrinsic asthma without status asthmaticus diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H33..11 Read Bronchial asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H331100 Read Intrinsic asthma with status asthmaticus diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H331.11 Read Late onset asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H331111 Read Intrinsic asthma with asthma attack diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H331z00 Read Intrinsic asthma NOS diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H332.00 Read Mixed asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H333.00 Read Acute exacerbation of asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 no
H334.00 Read Brittle asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H33z.00 Read Asthma unspecified diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H33z000 Read Status asthmaticus NOS test res43: asthma_kontopantelis_bmjqs2012 yes no
H33z011 Read Severe asthma attack diagnostic res43: asthma_kontopantelis_bmjqs2012 yes no
h33z100 Read Asthma attack diagnostic res43: asthma_kontopantelis_bmjqs2012 no
H33z100 Read Asthma attack diagnostic res43: asthma_kontopantelis_bmjqs2012 no
H33z.11 Read Hyperreactive airways disease diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
H33z111 Read Asthma attack NOS diagnostic res43: asthma_kontopantelis_bmjqs2012 no
H33z200 Read Late-onset asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H33zz00 Read Asthma NOS diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H33zz11 Read Exercise induced asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H33zz12 Read Allergic asthma NEC diagnostic res43: asthma_kontopantelis_bmjqs2012 yes yes
H35y600 Read Sequoiosis (red-cedar asthma) diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
H35y700 Read Wood asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
H47y000 Read Detergent asthma diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
3052AT OXMIS PSYCHOGENIC ASTHMA diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 OXMIS ASTHMA diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 AA OXMIS ASTHMA ACUTE diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 AB OXMIS ASTHMA ATTACK diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 AD OXMIS ASTHMA OCCASIONAL diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 AE OXMIS ASTHMA SEASONAL diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 AH OXMIS ASTHMA HOSPITALISED test res43: asthma_kontopantelis_bmjqs2012 no
493 AI OXMIS ASTHMA SEVERITY MILD diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 AJ OXMIS ASTHMA SEVERITY MODERATE diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 AK OXMIS ASTHMA SEVERITY SEVERE diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 AR OXMIS ASTHMA RESOLVED diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 BD OXMIS ASTHMA AND BRONCHITIS diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 BF OXMIS ASTHMA FREQUENCY RARELY diagnostic res43: asthma_kontopantelis_bmjqs2012 no
493 BG OXMIS ASTHMA FREQUENCY REGULARLY diagnostic res43: asthma_kontopantelis_bmjqs2012 no
493 BH OXMIS ASTHMA FREQUENCY CONSTANTLY diagnostic res43: asthma_kontopantelis_bmjqs2012 no
493 BI OXMIS ASTHMA FREQUENCY ON EXERCISE ONLY test res43: asthma_kontopantelis_bmjqs2012 no
493 BR OXMIS BRONCHIAL ASTHMA diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 C OXMIS CROUP ASTHMATIC diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 CH OXMIS CHILDHOOD ASTHMA diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 CJ OXMIS ASTHMA MEDICATION INTERMITTENTLY drug res43: asthma_kontopantelis_bmjqs2012 no
493 CK OXMIS ASTHMA MEDICATION PRN drug res43: asthma_kontopantelis_bmjqs2012 no
493 CL OXMIS ASTHMA MEDICATION REGULARLY drug res43: asthma_kontopantelis_bmjqs2012 no
493 CM OXMIS ASTHMA MEDICATION PROPHYLACTICLY drug res43: asthma_kontopantelis_bmjqs2012 no
493 D OXMIS STATUS ASTHMATICUS test res43: asthma_kontopantelis_bmjqs2012 no
493 EA OXMIS ASTHMA EXERCISE INCLUDED diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 EB OXMIS ASTHMA EXERCISE INDUCED diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 EP OXMIS ASTHMA EPISODIC diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 F OXMIS ASTHMATIC ALLERGY symptom res43: asthma_kontopantelis_bmjqs2012 no
493 GR OXMIS ASTHMA ALLERGIC GRASS diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 GS OXMIS ASTHMA POLLEN INITIATED diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 HT OXMIS INTRINSIC ASTHMA diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 JC OXMIS CHRONIC ASTHMA diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
493 KA OXMIS EXACERBATION OF ASTHMA diagnostic res43: asthma_kontopantelis_bmjqs2012 no
493 KB OXMIS ASTHMA EXACERBATION diagnostic res43: asthma_kontopantelis_bmjqs2012 no
493 NA OXMIS NOCTURNAL ASTHMA diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
691 TM OXMIS ECZEMA WITH ASTHMA diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
L4930LO OXMIS LATE ONSET ASTHMA diagnostic res43: asthma_kontopantelis_bmjqs2012 yes
Y0601JB OXMIS ASTHMA CLINIC ATTENDANCE test res43: asthma_kontopantelis_bmjqs2012 no
Y060 JB OXMIS CLINIC ASTHMA test res43: asthma_kontopantelis_bmjqs2012 no
Y060 LE OXMIS ASTHMA GROUP diagnostic res43: asthma_kontopantelis_bmjqs2012 no
Y100 AR OXMIS ASTHMA ROUTINE ASSESSMENT test res43: asthma_kontopantelis_bmjqs2012 no

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