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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: ht_kontopantelis_bmjqs2012

165 codes in list

Code Coding system Description Entity type List name conservative resolve
2126100 Read Hypertension resolved diagnostic res43: ht_kontopantelis_bmjqs2012 yes
212K.00 Read Hypertension resolved diagnostic res43: ht_kontopantelis_bmjqs2012 yes
662..12 Read Hypertension monitoring test res43: ht_kontopantelis_bmjqs2012 no
6627.00 Read Good hypertension control test res43: ht_kontopantelis_bmjqs2012 no
6628.00 Read Poor hypertension control test res43: ht_kontopantelis_bmjqs2012 no
6629.00 Read Hypertension:follow-up default test res43: ht_kontopantelis_bmjqs2012 no
662b.00 Read Moderate hypertension control test res43: ht_kontopantelis_bmjqs2012 no
662c.00 Read Hypertension six month review test res43: ht_kontopantelis_bmjqs2012 no
662d.00 Read Hypertension annual review test res43: ht_kontopantelis_bmjqs2012 no
662F.00 Read Hypertension treatm. started drug res43: ht_kontopantelis_bmjqs2012 no
662G.00 Read Hypertensive treatm.changed drug res43: ht_kontopantelis_bmjqs2012 no
662O.00 Read On treatment for hypertension drug res43: ht_kontopantelis_bmjqs2012 no
662P.00 Read Hypertension monitoring test res43: ht_kontopantelis_bmjqs2012 no
8B26.00 Read Antihypertensive therapy drug res43: ht_kontopantelis_bmjqs2012 no
8BL0.00 Read Patient on maximal tolerated antihypertensive therapy drug res43: ht_kontopantelis_bmjqs2012 no
8CR4.00 Read Hypertension clinical management plan test res43: ht_kontopantelis_bmjqs2012 no
8HT5.00 Read Referral to hypertension clinic test res43: ht_kontopantelis_bmjqs2012 no
9N03.00 Read Seen in hypertension clinic test res43: ht_kontopantelis_bmjqs2012 no
9N1y200 Read Seen in hypertension clinic test res43: ht_kontopantelis_bmjqs2012 no
9OI1.00 Read Attends hypertension monitor. test res43: ht_kontopantelis_bmjqs2012 no
9OIA.00 Read Hypertension monitor.chck done test res43: ht_kontopantelis_bmjqs2012 no
9OIA.11 Read Hypertension monitored test res43: ht_kontopantelis_bmjqs2012 no
F404200 Read Blind hypertensive eye symptom res43: ht_kontopantelis_bmjqs2012 no
F421300 Read Hypertensive retinopathy symptom res43: ht_kontopantelis_bmjqs2012 no
G2...00 Read Hypertensive disease diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G20..00 Read Essential hypertension diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G200.00 Read Malignant essential hypertension diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G201.00 Read Benign essential hypertension diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G20..11 Read High blood pressure symptom res43: ht_kontopantelis_bmjqs2012 no
G202.00 Read Systolic hypertension diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G20z.00 Read Essential hypertension NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G20z.11 Read Hypertension NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G21..00 Read Hypertensive heart disease diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G210.00 Read Malignant hypertensive heart disease diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G210000 Read Malignant hypertensive heart disease without CCF diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G210100 Read Malignant hypertensive heart disease with CCF diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G210z00 Read Malignant hypertensive heart disease NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G2...11 Read BP - hypertensive disease diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G211.00 Read Benign hypertensive heart disease diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G211000 Read Benign hypertensive heart disease without CCF diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G211100 Read Benign hypertensive heart disease with CCF diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G211z00 Read Benign hypertensive heart disease NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G21z.00 Read Hypertensive heart disease NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G21z000 Read Hypertensive heart disease NOS without CCF diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G21z011 Read Cardiomegaly - hypertensive diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G21z100 Read Hypertensive heart disease NOS with CCF diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G21zz00 Read Hypertensive heart disease NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G22..00 Read Hypertensive renal disease diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G220.00 Read Malignant hypertensive renal disease diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G221.00 Read Benign hypertensive renal disease diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G222.00 Read Hypertensive renal disease with renal failure diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G22z.00 Read Hypertensive renal disease NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G22z.11 Read Renal hypertension diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G23..00 Read Hypertensive heart and renal disease diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G230.00 Read Malignant hypertensive heart and renal disease diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G231.00 Read Benign hypertensive heart and renal disease diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G232.00 Read Hypertensive heart&renal dis wth (congestive) heart failure diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G233.00 Read Hypertensive heart and renal disease with renal failure diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G234.00 Read Hyperten heart&renal dis+both(congestv)heart and renal fail diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G23z.00 Read Hypertensive heart and renal disease NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G24..00 Read Secondary hypertension diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G240.00 Read Secondary malignant hypertension diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G240000 Read Secondary malignant renovascular hypertension diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G240z00 Read Secondary malignant hypertension NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G241.00 Read Secondary benign hypertension diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G241000 Read Secondary benign renovascular hypertension diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G241z00 Read Secondary benign hypertension NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G244.00 Read Hypertension secondary to endocrine disorders diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G24z.00 Read Secondary hypertension NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G24z000 Read Secondary renovascular hypertension NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G24zz00 Read Secondary hypertension NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G2y..00 Read Other specified hypertensive disease diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G2z..00 Read Hypertensive disease NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
G672.00 Read Hypertensive encephalopathy symptom res43: ht_kontopantelis_bmjqs2012 no
G672.11 Read Hypertensive crisis symptom res43: ht_kontopantelis_bmjqs2012 no
Gyu2000 Read [X]Other secondary hypertension diagnostic res43: ht_kontopantelis_bmjqs2012 yes
Gyu2100 Read [X]Hypertension secondary to other renal disorders diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L120.00 Read Benign essential hypertension in pregnancy/childbirth/puerp diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L120000 Read Benign essential hypertension in preg/childb/puerp unspec diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L120100 Read Benign essential hypertension in preg/childb/puerp - deliv diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L120300 Read Benign essential hypertension in preg/childb/puerp-not deliv diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L120400 Read Benign essential hypertension in preg/childb/puerp +p/n comp diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L120z00 Read Benign essential hypertension in preg/childb/puerp NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L121.00 Read Renal hypertension in pregnancy/childbirth/puerperium diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L121000 Read Renal hypertension in pregnancy/childbirth/puerp unspecified diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L121100 Read Renal hypertension in pregnancy/childbirth/puerp - delivered diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L121200 Read Renal hypertension in preg/childb/puerp -deliv with p/n comp diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L121300 Read Renal hypertension in preg/childbirth/puerp - not delivered diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L121400 Read Renal hypertension in preg/childb/puerp + p/n complication diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L121z00 Read Renal hypertension in pregnancy/childbirth/puerperium NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L122.00 Read Other pre-existing hypertension in preg/childbirth/puerp diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L122000 Read Other pre-existing hypertension in preg/childb/puerp unspec diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L122100 Read Other pre-existing hypertension in preg/childb/puerp - deliv diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L122300 Read Other pre-exist hypertension in preg/childb/puerp-not deliv diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L122400 Read Other pre-exist hypertension in preg/childb/puerp + p/n comp diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L122z00 Read Other pre-existing hypertension in preg/childb/puerp NOS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L128.00 Read Pre-exist hypertension compl preg childbirth and puerperium diagnostic res43: ht_kontopantelis_bmjqs2012 yes
L128200 Read Pre-exist 2ndry hypertens comp preg childbth and puerperium diagnostic res43: ht_kontopantelis_bmjqs2012 yes
3053HT OXMIS NEUROGENIC HYPERTENSION (SECONDARY) diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4000 OXMIS MALIGNANT HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4003 OXMIS HYPERTENSIVE NEPHROPATHY diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4003AA OXMIS HYPERTENSIVE RENAL DISEASE diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 OXMIS BENIGN HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 A OXMIS HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 AC OXMIS HYPERTENSION ACCELERATED diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 AR OXMIS HYPERTENSION ARTERIOSCLEROTIC diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 AT OXMIS HYPERTENSION ATHEROSCLEROTIC diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 B OXMIS RETINOPATHY HYPERTENSIVE symptom res43: ht_kontopantelis_bmjqs2012 no
401 BE OXMIS RETINOPATHY HYPERTENSIVE EXUDATES symptom res43: ht_kontopantelis_bmjqs2012 no
401 BH OXMIS RETINOPATHY HYPERTENSIVE HAEMORRHAGE symptom res43: ht_kontopantelis_bmjqs2012 no
401 BM OXMIS HYPERTENSION ON TREATMENT diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 BN OXMIS HYPERTENSION BENIGN diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 BP OXMIS RETINOPATHY HYPERTENSIVE PAPILLOEDEMA symptom res43: ht_kontopantelis_bmjqs2012 no
401 BR OXMIS HYPERTENSION RESOLVED diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 C OXMIS HYPERTENSION ESSENTIAL diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 DC OXMIS HYPERTENSION DIASTOLIC diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 E OXMIS HYPERTENSION ARTERIAL diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 EL OXMIS HYPERTENSION ARTERIAL SYSTEMIC diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 LB OXMIS HYPERTENSION LABILE INTERMITTENT diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 NC OXMIS HYPERTENSION NECROTIZING STAGES diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 P OXMIS HYPERTENSION ARTERIAL PRIMARY diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 PA OXMIS HYPERTENSION PRIMARY diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 R OXMIS HYPERTENSION CRISIS symptom res43: ht_kontopantelis_bmjqs2012 no
401 S OXMIS HYPERTENSION SYSTOLIC diagnostic res43: ht_kontopantelis_bmjqs2012 yes
401 T OXMIS THROMBOSIS HYPERTENSION symptom res43: ht_kontopantelis_bmjqs2012 no
402 OXMIS HYPERTENSIVE HEART DISEASE diagnostic res43: ht_kontopantelis_bmjqs2012 yes
402 C OXMIS HYPERTENSION CONGESTIVE HEART FAILURE diagnostic res43: ht_kontopantelis_bmjqs2012 yes
402 MF OXMIS MYOCARDIAL FIBROSIS WITH HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
402 VH OXMIS VENTRICULAR HYPERTROPHY HYPERTENSIVE diagnostic res43: ht_kontopantelis_bmjqs2012 yes
403 OXMIS RENAL HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
403 AA OXMIS RENAL HYPERTENSIVE DISEASE diagnostic res43: ht_kontopantelis_bmjqs2012 yes
403 AH OXMIS RENOVASCULAR HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
403 M OXMIS NEPHROPATHY MALIGNANT HYPERTENSION symptom res43: ht_kontopantelis_bmjqs2012 no
403 NC OXMIS HYPERTENSION IMPAIRED RENAL FUNCTION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
403 NF OXMIS HYPERTENSION RENAL INSUFFICIENCY diagnostic res43: ht_kontopantelis_bmjqs2012 yes
403 NG OXMIS HYPERTENSIVE GLOMERULOSCLEROSIS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
403 NH OXMIS NEPHROSCLEROSIS HYPERTENSIVE symptom res43: ht_kontopantelis_bmjqs2012 no
4100N OXMIS MYOCARDIAL INFARCT WITH HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4100NA OXMIS MYOCARDIAL INFARCT ACUTE WITH HYPERTENSI diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4100T OXMIS THROMBOSIS CORONARY WITH HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4120 OXMIS INSUFFICIENCY CORONARY HYPERTENSIVE diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4120A OXMIS ISCHAEMIC HEART DISEASE HYPERTENSIVE diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4120BD OXMIS SYNDROME DRESSLER'S WITH HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4120CA OXMIS CORONARY ARTERY DISEASE WITH HYPERTENSIO diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4120M OXMIS MYOCARDIAL ISCHAEMIA WITH HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4130 OXMIS ANGINA PECTORIS WITH HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4130E OXMIS ANGINA EFFORT WITH HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4140 OXMIS ASYMPTOMATIC HYPERTENSIVE ISCHAEMIC HEAR diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4300 OXMIS SUBARACHNOID HAEMORRHAGE WITH HYPERTENSI diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4310 OXMIS HAEMORRHAGE INTRACEREBRAL WITH HYPERTENS diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4330 OXMIS CEREBRAL THROMBOSIS WITH HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4340 OXMIS EMBOLISM CEREBRAL WITH HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4340CR OXMIS EMBOLISM INTRACRANIAL WITH HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4360A OXMIS CEREBROVASCULAR ACCIDENT WITH HYPERTENSI diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4360B OXMIS STROKE WITH HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4360D OXMIS HYPERTENSIVE ENCEPHALOPATHY diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4370 OXMIS CEREBRAL ISCHAEMIA HYPERTENSIVE diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4380 OXMIS CEREBROVASCULAR DISEASE WITH HYPERTENSIO diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4380HP OXMIS HEMIPLEGIA WITH HYPERTENSION diagnostic res43: ht_kontopantelis_bmjqs2012 yes
4419H OXMIS HYPERTENSION ANEURYSM AORTA diagnostic res43: ht_kontopantelis_bmjqs2012 yes
791 HP OXMIS HYPERTENSIVE HEADACHE symptom res43: ht_kontopantelis_bmjqs2012 no
L0010AM OXMIS SEEN IN HYPERTENSION CLINIC test res43: ht_kontopantelis_bmjqs2012 no
L0010EM OXMIS REFERRED TO HYPERTENSION CLINIC test res43: ht_kontopantelis_bmjqs2012 no
Y0601JA OXMIS HYPERTENSION CLINIC ATTENDANCE test res43: ht_kontopantelis_bmjqs2012 no
Y060 JA OXMIS HYPERTENSION CLINIC test res43: ht_kontopantelis_bmjqs2012 no

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