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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: depression_kontopantelis_bmjqs2012
124 codes in list
| Code | Coding system | Description | Entity type | List name | qof code | conservative | resolve |
|---|---|---|---|---|---|---|---|
| 1465.00 | Read | H/O: depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | no | ||
| 1B17.00 | Read | Depressed | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 1B17.11 | Read | C/O - feeling depressed | symptom | res43: depression_kontopantelis_bmjqs2012 | no | ||
| 1B1U.00 | Read | Symptoms of depression | symptom | res43: depression_kontopantelis_bmjqs2012 | no | ||
| 1B1U.11 | Read | Depressive symptoms | symptom | res43: depression_kontopantelis_bmjqs2012 | no | ||
| 1BT..00 | Read | Depressed mood | symptom | res43: depression_kontopantelis_bmjqs2012 | no | ||
| 212S.00 | Read | Depression resolved | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 2257.00 | Read | O/E - depressed | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 62T1.00 | Read | Puerperal depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 8CAa.00 | Read | Patient given advice about management of depression | test | res43: depression_kontopantelis_bmjqs2012 | no | ||
| 8HHq.00 | Read | Referral for guided self-help for depression | test | res43: depression_kontopantelis_bmjqs2012 | no | ||
| 9H90.00 | Read | Depression annual review | test | res43: depression_kontopantelis_bmjqs2012 | no | ||
| 9H91.00 | Read | Depression medication review | test | res43: depression_kontopantelis_bmjqs2012 | no | ||
| 9H92.00 | Read | Depression interim review | test | res43: depression_kontopantelis_bmjqs2012 | no | ||
| 9HA0.00 | Read | On depression register | test | res43: depression_kontopantelis_bmjqs2012 | no | ||
| 9HA1.00 | Read | Removed from depression register | test | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| E001300 | Read | Presenile dementia with depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E002100 | Read | Senile dementia with depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E004300 | Read | Arteriosclerotic dementia with depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| E112.00 | Read | Single major depressive episode | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E112000 | Read | Single major depressive episode, unspecified | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E112100 | Read | Single major depressive episode, mild | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E112.11 | Read | Agitated depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E112.12 | Read | Endogenous depression first episode | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E112.13 | Read | Endogenous depression first episode | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E112.14 | Read | Endogenous depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E112200 | Read | Single major depressive episode, moderate | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E112300 | Read | Single major depressive episode, severe, without psychosis | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E112500 | Read | Single major depressive episode, partial or unspec remission | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E112600 | Read | Single major depressive episode, in full remission | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E112z00 | Read | Single major depressive episode NOS | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E113.00 | Read | Recurrent major depressive episode | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E113000 | Read | Recurrent major depressive episodes, unspecified | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E113100 | Read | Recurrent major depressive episodes, mild | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E113.11 | Read | Endogenous depression - recurrent | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E113200 | Read | Recurrent major depressive episodes, moderate | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E113300 | Read | Recurrent major depressive episodes, severe, no psychosis | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E113500 | Read | Recurrent major depressive episodes,partial/unspec remission | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E113600 | Read | Recurrent major depressive episodes, in full remission | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E113700 | Read | Recurrent depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E113z00 | Read | Recurrent major depressive episode NOS | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E118.00 | Read | Seasonal affective disorder | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E11y200 | Read | Atypical depressive disorder | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E11z200 | Read | Masked depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E135.00 | Read | Agitated depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E200300 | Read | Anxiety with depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E204.00 | Read | Neurotic depression reactive type | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| E204.11 | Read | Postnatal depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| E211200 | Read | Depressive personality disorder | diagnostic | res43: depression_kontopantelis_bmjqs2012 | no | ||
| E290.00 | Read | Brief depressive reaction | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| E290z00 | Read | Brief depressive reaction NOS | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| E291.00 | Read | Prolonged depressive reaction | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| E2B..00 | Read | Depressive disorder NEC | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| E2B0.00 | Read | Postviral depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| E2B1.00 | Read | Chronic depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32.00 | Read | [X]Depressive episode | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu32000 | Read | [X]Mild depressive episode | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32100 | Read | [X]Moderate depressive episode | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32.11 | Read | [X]Single episode of depressive reaction | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu32.12 | Read | [X]Single episode of psychogenic depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu32.13 | Read | [X]Single episode of reactive depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu32200 | Read | [X]Severe depressive episode without psychotic symptoms | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32211 | Read | [X]Single episode agitated depressn w'out psychotic symptoms | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32212 | Read | [X]Single episode major depression w'out psychotic symptoms | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32213 | Read | [X]Single episode vital depression w'out psychotic symptoms | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32400 | Read | [X]Mild depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32y00 | Read | [X]Other depressive episodes | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32y11 | Read | [X]Atypical depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32y12 | Read | [X]Single episode of masked depression NOS | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32z00 | Read | [X]Depressive episode, unspecified | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32z11 | Read | [X]Depression NOS | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32z12 | Read | [X]Depressive disorder NOS | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32z13 | Read | [X]Prolonged single episode of reactive depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu32z14 | Read | [X] Reactive depression NOS | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu33.00 | Read | [X]Recurrent depressive disorder | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33000 | Read | [X]Recurrent depressive disorder, current episode mild | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33100 | Read | [X]Recurrent depressive disorder, current episode moderate | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33.11 | Read | [X]Recurrent episodes of depressive reaction | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33.12 | Read | [X]Recurrent episodes of psychogenic depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33.13 | Read | [X]Recurrent episodes of reactive depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33.14 | Read | [X]Seasonal depressive disorder | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33.15 | Read | [X]SAD - Seasonal affective disorder | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33200 | Read | [X]Recurr depress disorder cur epi severe without psyc sympt | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33211 | Read | [X]Endogenous depression without psychotic symptoms | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33212 | Read | [X]Major depression, recurrent without psychotic symptoms | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33214 | Read | [X]Vital depression, recurrent without psychotic symptoms | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33400 | Read | [X]Recurrent depressive disorder, currently in remission | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33y00 | Read | [X]Other recurrent depressive disorders | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33z00 | Read | [X]Recurrent depressive disorder, unspecified | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu33z11 | Read | [X]Monopolar depression NOS | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu34100 | Read | [X]Dysthymia | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu34111 | Read | [X]Depressive neurosis | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu34113 | Read | [X]Neurotic depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu34114 | Read | [X]Persistant anxiety depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu3y111 | Read | [X]Recurrent brief depressive episodes | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu41200 | Read | [X]Mixed anxiety and depressive disorder | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | yes | |
| Eu41211 | Read | [X]Mild anxiety depression | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu53011 | Read | [X]Postnatal depression NOS | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu53012 | Read | [X]Postpartum depression NOS | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| Eu92000 | Read | [X]Depressive conduct disorder | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 2960AC | OXMIS | CHRONIC AGITATED DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 2960AD | OXMIS | DEPRESSION AGITATED | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 2962A | OXMIS | DEPRESSION CHRONIC | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 2962AF | OXMIS | REACTION DEPRESSIVE AFFECTIVE | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 2962B | OXMIS | DEPRESSION ACUTE | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 2962EN | OXMIS | ENDOGENOUS DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 2962R | OXMIS | RECURRENT DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3000E | OXMIS | ANXIETY DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3004 | OXMIS | NEUROSIS DEPRESSIVE | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3004A | OXMIS | DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3004AB | OXMIS | OBSERVED DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3004AM | OXMIS | MOOD DEPRESSED | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3004B | OXMIS | PREGNANCY DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3004C | OXMIS | PUERPERAL DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3004CA | OXMIS | POSTNATAL DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3004E | OXMIS | EXOGENOUS DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3004ER | OXMIS | REACTIVE DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3004M | OXMIS | MORNING DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3004PP | OXMIS | POSTOPERATIVE DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3091N | OXMIS | INFLUENZAL DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3091PF | OXMIS | POSTINFECTIVE DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3091PL | OXMIS | DEPRESSION POSTVIRAL | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 3091PN | OXMIS | POSTINFLUENZA DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes | ||
| 7902DC | OXMIS | POSTVIRAL DEPRESSION | diagnostic | res43: depression_kontopantelis_bmjqs2012 | yes |
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