ClinicalCodes.org
An online clinical codes repository to improve validity and reproducibility of medical database research
Research article:
Withdrawing Performance Indicators: Retrospective Analysis of General Practice Performance Under the UKs Quality and Outcomes Framework
Reference:
Kontopantelis, Evangelos; Springate, David; Reeves, David; Ashcroft, Darren; Valderas, Jose M; Doran, Tim(2014) Withdrawing Performance Indicators: Retrospective Analysis of General Practice Performance Under the UKs Quality and Outcomes Framework. British Medical Journal, doi: http://dx.doi.org/10.1136/bmj.g330
- Link to fulltext article
- Abstract
- Objectives: To investigate the effect of withdrawing incentives on recorded quality of care, in the context of the UK Quality and Outcomes Framework pay-for-performance scheme. Design: Retrospective longitudinal study. Setting: Data for 644 general practices, from 2004/5 to 2011/12, extracted from the Clinical Practice Research Datalink. Participants: All patients registered with any of the practices over the study period, 13,772,992 in total. Intervention: The removal of financial incentives for aspects of care for patients with asthma, coronary heart disease, diabetes, stroke and psychosis. Main outcome measures: Performance on eight clinical quality indicators withdrawn from a national incentive scheme: influenza immunisation (asthma) and lithium therapy monitoring (psychosis), removed in April 2006; blood pressure monitoring (coronary heart disease, diabetes, stroke), cholesterol level monitoring (coronary heart disease, diabetes) and blood glucose monitoring (diabetes), removed in April 2011. Multilevel mixed effects multiple linear regression models were used to quantify the effect of incentive withdrawal. Results: Mean levels of performance were generally stable after the removal of the incentives, both short- and long-term. For the two indicators removed in April 2006/7, levels in 2011/12 were very close to 2005/6 levels, although a small but statistically significant drop was estimated for influenza immunisation. For five of the six indicators withdrawn in from April 2011/12, there was no significant impact on performance in that year following removal and differences between predicted and observed scores were small. Performance on related outcome indicators retained in the scheme (e.g. blood pressure control) was generally unaffected. Conclusions: Following the removal of incentives, levels of performance across a range of clinical activities generally remained stable. This indicates that health benefits from incentive schemes can potentially be increased by periodically replacing existing indicators with new indicators relating to alternative aspects of care. However, most of the aspects of care we investigated remained indirectly incentivised and further work is required to assess the generalisability of the findings when incentives are fully withdrawn.
- Author for correspondence
- Evangelos Kontopantelis
- Email for correspondence
- e.kontopantelis@manchester.ac.uk
Code list: asthma_clinicals
66 codes in list
| Code | Coding system | Description | Entity type | List name | resolve_code | ||
|---|---|---|---|---|---|---|---|
| 173A.00 | Read | Exercise induced asthma | diagnostic | asthma_clinicals | 0 | ||
| 173c.00 | Read | Occupational asthma | diagnostic | asthma_clinicals | 0 | ||
| 173d.00 | Read | Work aggravated asthma | diagnostic | asthma_clinicals | 0 | ||
| 1780.00 | Read | Aspirin induced asthma | diagnostic | asthma_clinicals | 0 | ||
| 1O2..00 | Read | Asthma confirmed | diagnostic | asthma_clinicals | 0 | ||
| 2126200 | Read | Asthma resolved | diagnostic | asthma_clinicals | 1 | ||
| 212G.00 | Read | Asthma resolved | diagnostic | asthma_clinicals | 1 | ||
| 663j.00 | Read | Asthma - currently active | diagnostic | asthma_clinicals | 0 | ||
| 663V000 | Read | Occasional asthma | diagnostic | asthma_clinicals | 0 | ||
| 663V100 | Read | Mild asthma | diagnostic | asthma_clinicals | 0 | ||
| 663V200 | Read | Moderate asthma | diagnostic | asthma_clinicals | 0 | ||
| 663V300 | Read | Severe asthma | diagnostic | asthma_clinicals | 0 | ||
| H312000 | Read | Chronic asthmatic bronchitis | diagnostic | asthma_clinicals | 0 | ||
| H33..00 | Read | Asthma | diagnostic | asthma_clinicals | 0 | ||
| H330.00 | Read | Extrinsic (atopic) asthma | diagnostic | asthma_clinicals | 0 | ||
| H330000 | Read | Extrinsic asthma without status asthmaticus | diagnostic | asthma_clinicals | 0 | ||
| H330011 | Read | Hay fever with asthma | diagnostic | asthma_clinicals | 0 | ||
| H330100 | Read | Extrinsic asthma with status asthmaticus | diagnostic | asthma_clinicals | 0 | ||
| H330.11 | Read | Allergic asthma | diagnostic | asthma_clinicals | 0 | ||
| H330111 | Read | Extrinsic asthma with asthma attack | diagnostic | asthma_clinicals | 0 | ||
| H330.12 | Read | Childhood asthma | diagnostic | asthma_clinicals | 0 | ||
| H330.13 | Read | Hay fever with asthma | diagnostic | asthma_clinicals | 0 | ||
| H330.14 | Read | Pollen asthma | diagnostic | asthma_clinicals | 0 | ||
| H330z00 | Read | Extrinsic asthma NOS | diagnostic | asthma_clinicals | 0 | ||
| H331.00 | Read | Intrinsic asthma | diagnostic | asthma_clinicals | 0 | ||
| H331000 | Read | Intrinsic asthma without status asthmaticus | diagnostic | asthma_clinicals | 0 | ||
| H33..11 | Read | Bronchial asthma | diagnostic | asthma_clinicals | 0 | ||
| H331100 | Read | Intrinsic asthma with status asthmaticus | diagnostic | asthma_clinicals | 0 | ||
| H331.11 | Read | Late onset asthma | diagnostic | asthma_clinicals | 0 | ||
| H331111 | Read | Intrinsic asthma with asthma attack | diagnostic | asthma_clinicals | 0 | ||
| H331z00 | Read | Intrinsic asthma NOS | diagnostic | asthma_clinicals | 0 | ||
| H332.00 | Read | Mixed asthma | diagnostic | asthma_clinicals | 0 | ||
| H334.00 | Read | Brittle asthma | diagnostic | asthma_clinicals | 0 | ||
| H33z.00 | Read | Asthma unspecified | diagnostic | asthma_clinicals | 0 | ||
| H33z.11 | Read | Hyperreactive airways disease | diagnostic | asthma_clinicals | 0 | ||
| H33z200 | Read | Late-onset asthma | diagnostic | asthma_clinicals | 0 | ||
| H33zz00 | Read | Asthma NOS | diagnostic | asthma_clinicals | 0 | ||
| H33zz11 | Read | Exercise induced asthma | diagnostic | asthma_clinicals | 0 | ||
| H33zz12 | Read | Allergic asthma NEC | diagnostic | asthma_clinicals | 0 | ||
| H35y600 | Read | Sequoiosis (red-cedar asthma) | diagnostic | asthma_clinicals | 0 | ||
| H35y700 | Read | Wood asthma | diagnostic | asthma_clinicals | 0 | ||
| H47y000 | Read | Detergent asthma | diagnostic | asthma_clinicals | 0 | ||
| 3052AT | OXMIS | PSYCHOGENIC ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 493 | OXMIS | ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 493 AA | OXMIS | ASTHMA ACUTE | diagnostic | asthma_clinicals | 0 | ||
| 493 AB | OXMIS | ASTHMA ATTACK | diagnostic | asthma_clinicals | 0 | ||
| 493 AD | OXMIS | ASTHMA OCCASIONAL | diagnostic | asthma_clinicals | 0 | ||
| 493 AE | OXMIS | ASTHMA SEASONAL | diagnostic | asthma_clinicals | 0 | ||
| 493 AI | OXMIS | ASTHMA SEVERITY MILD | diagnostic | asthma_clinicals | 0 | ||
| 493 AJ | OXMIS | ASTHMA SEVERITY MODERATE | diagnostic | asthma_clinicals | 0 | ||
| 493 AK | OXMIS | ASTHMA SEVERITY SEVERE | diagnostic | asthma_clinicals | 0 | ||
| 493 AR | OXMIS | ASTHMA RESOLVED | diagnostic | asthma_clinicals | 1 | ||
| 493 BD | OXMIS | ASTHMA AND BRONCHITIS | diagnostic | asthma_clinicals | 0 | ||
| 493 BR | OXMIS | BRONCHIAL ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 493 C | OXMIS | CROUP ASTHMATIC | diagnostic | asthma_clinicals | 0 | ||
| 493 CH | OXMIS | CHILDHOOD ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 493 EA | OXMIS | ASTHMA EXERCISE INCLUDED | diagnostic | asthma_clinicals | 0 | ||
| 493 EB | OXMIS | ASTHMA EXERCISE INDUCED | diagnostic | asthma_clinicals | 0 | ||
| 493 EP | OXMIS | ASTHMA EPISODIC | diagnostic | asthma_clinicals | 0 | ||
| 493 GR | OXMIS | ASTHMA ALLERGIC GRASS | diagnostic | asthma_clinicals | 0 | ||
| 493 GS | OXMIS | ASTHMA POLLEN INITIATED | diagnostic | asthma_clinicals | 0 | ||
| 493 HT | OXMIS | INTRINSIC ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 493 JC | OXMIS | CHRONIC ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 493 NA | OXMIS | NOCTURNAL ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| 691 TM | OXMIS | ECZEMA WITH ASTHMA | diagnostic | asthma_clinicals | 0 | ||
| L4930LO | OXMIS | LATE ONSET ASTHMA | diagnostic | asthma_clinicals | 0 |
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Asthma diagnosis is defined as a patient having at least one code from [asthma_clinicals] up to the end of the QOF year in question plus at least one code from [asthma_drugs] in the preceding year. Patients whose most recent clinical code in a year is a resolve code in a given year are not included in the definition.