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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: chd_kontopantelis_bmjqs2012
147 codes in list
| Code | Coding system | Description | Entity type | List name | qof code | conservative | |
|---|---|---|---|---|---|---|---|
| 14AJ.00 | Read | H/O: Angina in last year | diagnostic | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 662K.00 | Read | Angina control | test | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 662K000 | Read | Angina control - good | test | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 662K100 | Read | Angina control - poor | test | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 662K200 | Read | Angina control - improving | test | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 662K300 | Read | Angina control - worsening | test | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 662Kz00 | Read | Angina control NOS | test | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 662N.00 | Read | CHD monitoring | test | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 6A2..00 | Read | Coronary heart disease annual review | test | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 6A4..00 | Read | Coronary heart disease review | test | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 8B27.00 | Read | Antianginal therapy | drug | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 8B3k.00 | Read | Coronary heart disease medication review | drug | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 8B63.11 | Read | Aspirin prophylaxis - IHD | drug | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 8CR6.00 | Read | Coronary heart disease risk clinical management plan | test | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 9Ob0.00 | Read | Attends coronary heart disease monitoring | test | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 9Ob8.00 | Read | Coronary heart disease monitoring check done | test | res43: chd_kontopantelis_bmjqs2012 | no | ||
| G3...00 | Read | Ischaemic heart disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G30..00 | Read | Acute myocardial infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G300.00 | Read | Acute anterolateral infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G301.00 | Read | Other specified anterior myocardial infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G301000 | Read | Acute anteroapical infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30..11 | Read | Attack - heart | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G301100 | Read | Acute anteroseptal infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30..12 | Read | Coronary thrombosis | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30..13 | Read | Cardiac rupture following myocardial infarction (MI) | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30..14 | Read | Heart attack | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30..15 | Read | MI - acute myocardial infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30..16 | Read | Thrombosis - coronary | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30..17 | Read | Silent myocardial infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G301z00 | Read | Anterior myocardial infarction NOS | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G302.00 | Read | Acute inferolateral infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G303.00 | Read | Acute inferoposterior infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G304.00 | Read | Posterior myocardial infarction NOS | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G305.00 | Read | Lateral myocardial infarction NOS | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G306.00 | Read | True posterior myocardial infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G307.00 | Read | Acute subendocardial infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G307000 | Read | Acute non-Q wave infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G307100 | Read | Acute non-ST segment elevation myocardial infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G308.00 | Read | Inferior myocardial infarction NOS | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G309.00 | Read | Acute Q-wave infarct | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30A.00 | Read | Mural thrombosis | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30B.00 | Read | Acute posterolateral myocardial infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30X.00 | Read | Acute transmural myocardial infarction of unspecif site | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30X000 | Read | Acute ST segment elevation myocardial infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30y.00 | Read | Other acute myocardial infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30y000 | Read | Acute atrial infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30y100 | Read | Acute papillary muscle infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30y200 | Read | Acute septal infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30yz00 | Read | Other acute myocardial infarction NOS | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G30z.00 | Read | Acute myocardial infarction NOS | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G31..00 | Read | Other acute and subacute ischaemic heart disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G310.00 | Read | Postmyocardial infarction syndrome | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G310.11 | Read | Dressler's syndrome | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G3...11 | Read | Arteriosclerotic heart disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G311.00 | Read | Preinfarction syndrome | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G311000 | Read | Myocardial infarction aborted | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G311011 | Read | MI - myocardial infarction aborted | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G311100 | Read | Unstable angina | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G311.11 | Read | Crescendo angina | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G311.12 | Read | Impending infarction | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G311.13 | Read | Unstable angina | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G311.14 | Read | Angina at rest | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G311200 | Read | Angina at rest | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G311300 | Read | Refractory angina | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G311400 | Read | Worsening angina | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G311500 | Read | Acute coronary syndrome | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G311z00 | Read | Preinfarction syndrome NOS | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G3...12 | Read | Atherosclerotic heart disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G312.00 | Read | Coronary thrombosis not resulting in myocardial infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G3...13 | Read | IHD - Ischaemic heart disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G31y.00 | Read | Other acute and subacute ischaemic heart disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G31y000 | Read | Acute coronary insufficiency | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G31y100 | Read | Microinfarction of heart | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G31y200 | Read | Subendocardial ischaemia | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G31y300 | Read | Transient myocardial ischaemia | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G31yz00 | Read | Other acute and subacute ischaemic heart disease NOS | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G32..00 | Read | Old myocardial infarction | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G32..11 | Read | Healed myocardial infarction | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G32..12 | Read | Personal history of myocardial infarction | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G33..00 | Read | Angina pectoris | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G330.00 | Read | Angina decubitus | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G330000 | Read | Nocturnal angina | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G330z00 | Read | Angina decubitus NOS | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G331.00 | Read | Prinzmetal's angina | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G331.11 | Read | Variant angina pectoris | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G332.00 | Read | Coronary artery spasm | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G33z.00 | Read | Angina pectoris NOS | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G33z000 | Read | Status anginosus | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G33z100 | Read | Stenocardia | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G33z200 | Read | Syncope anginosa | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G33z300 | Read | Angina on effort | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G33z400 | Read | Ischaemic chest pain | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G33z500 | Read | Post infarct angina | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G33z600 | Read | New onset angina | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G33z700 | Read | Stable angina | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G33zz00 | Read | Angina pectoris NOS | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G34..00 | Read | Other chronic ischaemic heart disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G340.00 | Read | Coronary atherosclerosis | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G340000 | Read | Single coronary vessel disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G340100 | Read | Double coronary vessel disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G340.11 | Read | Triple vessel disease of the heart | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G340.12 | Read | Coronary artery disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G342.00 | Read | Atherosclerotic cardiovascular disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G343.00 | Read | Ischaemic cardiomyopathy | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G344.00 | Read | Silent myocardial ischaemia | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G34y.00 | Read | Other specified chronic ischaemic heart disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G34y000 | Read | Chronic coronary insufficiency | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G34y100 | Read | Chronic myocardial ischaemia | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G34yz00 | Read | Other specified chronic ischaemic heart disease NOS | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G34z.00 | Read | Other chronic ischaemic heart disease NOS | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G34z000 | Read | Asymptomatic coronary heart disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G35..00 | Read | Subsequent myocardial infarction | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G350.00 | Read | Subsequent myocardial infarction of anterior wall | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G351.00 | Read | Subsequent myocardial infarction of inferior wall | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G353.00 | Read | Subsequent myocardial infarction of other sites | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G35X.00 | Read | Subsequent myocardial infarction of unspecified site | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G36..00 | Read | Certain current complication follow acute myocardial infarct | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G360.00 | Read | Haemopericardium/current comp folow acut myocard infarct | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G361.00 | Read | Atrial septal defect/curr comp folow acut myocardal infarct | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G362.00 | Read | Ventric septal defect/curr comp fol acut myocardal infarctn | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G363.00 | Read | Ruptur cardiac wall w'out haemopericard/cur comp fol ac MI | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G364.00 | Read | Ruptur chordae tendinae/curr comp fol acute myocard infarct | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G365.00 | Read | Rupture papillary muscle/curr comp fol acute myocard infarct | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G366.00 | Read | Thrombosis atrium,auric append&vent/curr comp foll acute MI | symptom | res43: chd_kontopantelis_bmjqs2012 | yes | no | |
| G3y..00 | Read | Other specified ischaemic heart disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| G3z..00 | Read | Ischaemic heart disease NOS | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| Gyu3.00 | Read | [X]Ischaemic heart diseases | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| Gyu3200 | Read | [X]Other forms of acute ischaemic heart disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| Gyu3300 | Read | [X]Other forms of chronic ischaemic heart disease | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | yes | |
| 4119B | OXMIS | ISCHAEMIC HEART DISEASE SUBACUTE | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4120A | OXMIS | ISCHAEMIC HEART DISEASE HYPERTENSIVE | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4129 | OXMIS | ISCHAEMIC HEART DISEASE CHRONIC | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4129AN | OXMIS | ISCHAEMIC HEART DISEASE | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4129N | OXMIS | ISCHAEMIC HEART DISEASE ASYMPTOMATIC | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4130 | OXMIS | ANGINA PECTORIS WITH HYPERTENSION | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4130E | OXMIS | ANGINA EFFORT WITH HYPERTENSION | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4139 | OXMIS | ANGINA PECTORIS | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4139AA | OXMIS | ANGINA ATTACK | diagnostic | res43: chd_kontopantelis_bmjqs2012 | no | ||
| 4139AT | OXMIS | ANGINA ATYPICAL | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4139C | OXMIS | CARDIAC ANGINA | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4139CO | OXMIS | ANGINA CRESCENDO | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4139E | OXMIS | ANGINA EFFORT | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4139M | OXMIS | SYNDROME ANGINAL | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4139N | OXMIS | ANGINA | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4139PA | OXMIS | ANGINA INVERSA | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4139U | OXMIS | UNSTABLE ANGINA | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes | ||
| 4149 | OXMIS | ASYMPTOMATIC ISCHAEMIC HEART DISEASE | diagnostic | res43: chd_kontopantelis_bmjqs2012 | yes |
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