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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: stroke_kontopantelis_bmjqs2012
105 codes in list
| Code | Coding system | Description | Entity type | List name | qof code | conservative | |
|---|---|---|---|---|---|---|---|
| 14A7.00 | Read | H/O: CVA/stroke | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| 14A7.12 | Read | H/O: stroke | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| 14AB.00 | Read | H/O: TIA | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| 14AK.00 | Read | H/O: Stroke in last year | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| 662e.00 | Read | Stroke/CVA annual review | test | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| 662M.00 | Read | Stroke monitoring | test | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| 662o.00 | Read | Haemorrhagic stroke monitoring | test | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| 7P24200 | Read | Delivery of rehabilitation for stroke | test | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| 8HBJ.00 | Read | Stroke / transient ischaemic attack referral | test | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| 8HHM.00 | Read | Ref to multidisciplinary stroke function improvement service | test | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| 8HTQ.00 | Read | Referral to stroke clinic | test | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| 9N0p.00 | Read | Seen in stroke clinic | test | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| F423600 | Read | Amaurosis fugax | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | no | |
| G61..00 | Read | Intracerebral haemorrhage | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G610.00 | Read | Cortical haemorrhage | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G611.00 | Read | Internal capsule haemorrhage | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G61..11 | Read | CVA - cerebrovascular accid due to intracerebral haemorrhage | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G61..12 | Read | Stroke due to intracerebral haemorrhage | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G612.00 | Read | Basal nucleus haemorrhage | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G613.00 | Read | Cerebellar haemorrhage | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G614.00 | Read | Pontine haemorrhage | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G615.00 | Read | Bulbar haemorrhage | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G616.00 | Read | External capsule haemorrhage | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G618.00 | Read | Intracerebral haemorrhage, multiple localized | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G61X.00 | Read | Intracerebral haemorrhage in hemisphere, unspecified | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G61X000 | Read | Left sided intracerebral haemorrhage, unspecified | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G61X100 | Read | Right sided intracerebral haemorrhage, unspecified | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G61z.00 | Read | Intracerebral haemorrhage NOS | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G63y000 | Read | Cerebral infarct due to thrombosis of precerebral arteries | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G63y100 | Read | Cerebral infarction due to embolism of precerebral arteries | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G64..00 | Read | Cerebral arterial occlusion | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G640.00 | Read | Cerebral thrombosis | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G640000 | Read | Cerebral infarction due to thrombosis of cerebral arteries | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G641.00 | Read | Cerebral embolism | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G641000 | Read | Cerebral infarction due to embolism of cerebral arteries | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G64..11 | Read | CVA - cerebral artery occlusion | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G641.11 | Read | Cerebral embolus | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G64..12 | Read | Infarction - cerebral | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G64..13 | Read | Stroke due to cerebral arterial occlusion | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G64z.00 | Read | Cerebral infarction NOS | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G64z000 | Read | Brainstem infarction | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G64z100 | Read | Wallenberg syndrome | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G64z.11 | Read | Brainstem infarction NOS | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G64z111 | Read | Lateral medullary syndrome | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G64z.12 | Read | Cerebellar infarction | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G64z200 | Read | Left sided cerebral infarction | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G64z300 | Read | Right sided cerebral infarction | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G64z400 | Read | Infarction of basal ganglia | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G65..00 | Read | Transient cerebral ischaemia | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G650.00 | Read | Basilar artery syndrome | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G650.11 | Read | Insufficiency - basilar artery | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G651.00 | Read | Vertebral artery syndrome | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G651000 | Read | Vertebro-basilar artery syndrome | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G65..11 | Read | Drop attack | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G65..12 | Read | Transient ischaemic attack | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G65..13 | Read | Vertebro-basilar insufficiency | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G652.00 | Read | Subclavian steal syndrome | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G653.00 | Read | Carotid artery syndrome hemispheric | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G654.00 | Read | Multiple and bilateral precerebral artery syndromes | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G656.00 | Read | Vertebrobasilar insufficiency | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G65y.00 | Read | Other transient cerebral ischaemia | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G65z.00 | Read | Transient cerebral ischaemia NOS | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G65z000 | Read | Impending cerebral ischaemia | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G65z100 | Read | Intermittent cerebral ischaemia | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G65zz00 | Read | Transient cerebral ischaemia NOS | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G66..00 | Read | Stroke and cerebrovascular accident unspecified | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G660.00 | Read | Middle cerebral artery syndrome | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G661.00 | Read | Anterior cerebral artery syndrome | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G66..11 | Read | CVA unspecified | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G66..12 | Read | Stroke unspecified | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G66..13 | Read | CVA - Cerebrovascular accident unspecified | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G662.00 | Read | Posterior cerebral artery syndrome | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G663.00 | Read | Brain stem stroke syndrome | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G664.00 | Read | Cerebellar stroke syndrome | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G665.00 | Read | Pure motor lacunar syndrome | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G666.00 | Read | Pure sensory lacunar syndrome | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G667.00 | Read | Left sided CVA | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G668.00 | Read | Right sided CVA | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G68X.00 | Read | Sequelae of stroke,not specfd as h'morrhage or infarction | symptom | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| G6W..00 | Read | Cereb infarct due unsp occlus/stenos precerebr arteries | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| G6X..00 | Read | Cerebrl infarctn due/unspcf occlusn or sten/cerebrl artrs | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| Gyu6200 | Read | [X]Other intracerebral haemorrhage | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| Gyu6300 | Read | [X]Cerebrl infarctn due/unspcf occlusn or sten/cerebrl artrs | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| Gyu6400 | Read | [X]Other cerebral infarction | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| Gyu6500 | Read | [X]Occlusion and stenosis of other precerebral arteries | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| Gyu6600 | Read | [X]Occlusion and stenosis of other cerebral arteries | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| Gyu6C00 | Read | [X]Sequelae of stroke,not specfd as h'morrhage or infarction | symptom | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| Gyu6D00 | Read | [X]Sequelae/other + unspecified cerebrovascular diseases | symptom | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| Gyu6F00 | Read | [X]Intracerebral haemorrhage in hemisphere, unspecified | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | no | |
| Gyu6G00 | Read | [X]Cereb infarct due unsp occlus/stenos precerebr arteries | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | yes | |
| L440.11 | Read | CVA - cerebrovascular accident in the puerperium | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | ||
| L440.12 | Read | Stroke in the puerperium | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | ||
| ZV12511 | Read | [V]Personal history of stroke | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| ZV12512 | Read | [V]Personal history of cerebrovascular accident (CVA) | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| 4350AT | OXMIS | TRANSIENT ISCHAEMIC ATTACKS WITH HYPERTE | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | ||
| 4359AT | OXMIS | TRANSIENT ISCHAEMIC ATTACKS | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | ||
| 4360A | OXMIS | CEREBROVASCULAR ACCIDENT WITH HYPERTENSI | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | ||
| 4360B | OXMIS | STROKE WITH HYPERTENSION | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | ||
| 4369A | OXMIS | CVA (CEREBROVASCULAR ACCIDENT) | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | ||
| 4369AL | OXMIS | CEREBROVASCULAR ACCIDENT LEFT | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | ||
| 4369AR | OXMIS | CEREBROVASCULAR ACCIDENT RIGHT | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | ||
| 4369B | OXMIS | STROKE | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | ||
| 4369BN | OXMIS | SYNDROME STROKE | diagnostic | res43: stroke_kontopantelis_bmjqs2012 | yes | ||
| 4389PN | OXMIS | SYNDROME POSTSTROKE | symptom | res43: stroke_kontopantelis_bmjqs2012 | no | ||
| 4389PP | OXMIS | POSTSTROKE PARALYSIS | symptom | res43: stroke_kontopantelis_bmjqs2012 | no |
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