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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: copd_kontopantelis_bmjqs2012
66 codes in list
| Code | Coding system | Description | Entity type | List name | qof code | conservative | |
|---|---|---|---|---|---|---|---|
| 66YB.00 | Read | Chronic obstructive pulmonary disease monitoring | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66Yd.00 | Read | COPD accident and emergency attendance since last visit | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66YD.00 | Read | Chronic obstructive pulmonary disease monitoring due | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66Ye.00 | Read | Emergency COPD admission since last appointment | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66Yf.00 | Read | Number of COPD exacerbations in past year | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66Yg.00 | Read | Chronic obstructive pulmonary disease disturbs sleep | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66Yh.00 | Read | Chronic obstructive pulmonary disease does not disturb sleep | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66Yi.00 | Read | Multiple COPD emergency hospital admissions | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66YI.00 | Read | COPD self-management plan given | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66YL.00 | Read | Chronic obstructive pulmonary disease follow-up | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66YL.11 | Read | COPD follow-up | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66YL.12 | Read | COAD follow-up | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66YM.00 | Read | Chronic obstructive pulmonary disease annual review | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66YS.00 | Read | Chronic obstructive pulmonary disease monitoring by nurse | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 66YT.00 | Read | Chronic obstructive pulmonary disease monitoring by doctor | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 8H2R.00 | Read | Admit COPD emergency | test | res43: copd_kontopantelis_bmjqs2012 | no | ||
| H3...00 | Read | Chronic obstructive pulmonary disease | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H31..00 | Read | Chronic bronchitis | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H310.00 | Read | Simple chronic bronchitis | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H310000 | Read | Chronic catarrhal bronchitis | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H310z00 | Read | Simple chronic bronchitis NOS | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H311.00 | Read | Mucopurulent chronic bronchitis | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H311000 | Read | Purulent chronic bronchitis | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H311100 | Read | Fetid chronic bronchitis | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H311z00 | Read | Mucopurulent chronic bronchitis NOS | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H312.00 | Read | Obstructive chronic bronchitis | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H312000 | Read | Chronic asthmatic bronchitis | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H312011 | Read | Chronic wheezy bronchitis | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H312100 | Read | Emphysematous bronchitis | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H312200 | Read | Acute exacerbation of chronic obstructive airways disease | symptom | res43: copd_kontopantelis_bmjqs2012 | no | ||
| H312300 | Read | Bronchiolitis obliterans | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H312z00 | Read | Obstructive chronic bronchitis NOS | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H313.00 | Read | Mixed simple and mucopurulent chronic bronchitis | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H31y.00 | Read | Other chronic bronchitis | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H31y100 | Read | Chronic tracheobronchitis | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H31yz00 | Read | Other chronic bronchitis NOS | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H31z.00 | Read | Chronic bronchitis NOS | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H32..00 | Read | Emphysema | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H320.00 | Read | Chronic bullous emphysema | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H320000 | Read | Segmental bullous emphysema | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H320100 | Read | Zonal bullous emphysema | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H320200 | Read | Giant bullous emphysema | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H320300 | Read | Bullous emphysema with collapse | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H320z00 | Read | Chronic bullous emphysema NOS | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H321.00 | Read | Panlobular emphysema | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H322.00 | Read | Centrilobular emphysema | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H32y.00 | Read | Other emphysema | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H32y000 | Read | Acute vesicular emphysema | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H32y100 | Read | Atrophic (senile) emphysema | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H32y111 | Read | Acute interstitial emphysema | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H32y200 | Read | MacLeod's unilateral emphysema | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H32yz00 | Read | Other emphysema NOS | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H32z.00 | Read | Emphysema NOS | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H36..00 | Read | Mild chronic obstructive pulmonary disease | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H37..00 | Read | Moderate chronic obstructive pulmonary disease | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H38..00 | Read | Severe chronic obstructive pulmonary disease | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H3y..11 | Read | Other specified chronic obstructive pulmonary disease | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| H3z..11 | Read | Chronic obstructive pulmonary disease NOS | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | yes | |
| 491 | OXMIS | CHRONIC BRONCHITIS | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | ||
| 491 E | OXMIS | CHRONIC BRONCHITIS WITH EMPHYSEMA | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | ||
| 492 | OXMIS | EMPHYSEMA PULMONARY | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | ||
| 492 AC | OXMIS | EMPHYSEMA APICAL BULLAE | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | ||
| 5199G | OXMIS | OBSTRUCTIVE AIRWAYS DISEASE CHRONIC | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | ||
| 5199GE | OXMIS | EXACERBATION COAD | symptom | res43: copd_kontopantelis_bmjqs2012 | no | ||
| 5199GL | OXMIS | COLD (CHRONIC OBSTRUCTIVE LUNG DISEASE) | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes | ||
| 5199GP | OXMIS | COPD (CHRONIC OBSTRUCTIVE PULMONARY DISE | diagnostic | res43: copd_kontopantelis_bmjqs2012 | yes |
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