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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 Main outcome measures: Performance on eight clinical quality indicators withdrawn from a national incentive scheme: influenza immunisation (asthma) and lithium therapy monitoring (psychosis), removed in April 2006; blood pressure monitoring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 For five of the six indicators withdrawn in from April 2011/12, there was no significant impact on performance in that year following removal and differences between predicted and observed scores were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: Body_mass_index

65 codes in list

Code Coding system Description Entity type List name
22A..00 Read O/E - weight observation Body_mass_index
22A1.00 Read O/E - weight > 20% below ideal observation Body_mass_index
22A2.00 Read O/E -weight 10-20% below ideal observation Body_mass_index
22A3.00 Read O/E - weight within 10% ideal observation Body_mass_index
22A4.00 Read O/E - weight 10-20% over ideal observation Body_mass_index
22A4.11 Read O/E - overweight observation Body_mass_index
22A5.00 Read O/E - weight > 20% over ideal observation Body_mass_index
22A5.11 Read O/E - obese observation Body_mass_index
22A6.00 Read O/E - Underweight observation Body_mass_index
22K..00 Read Body Mass Index observation Body_mass_index
22K1.00 Read Body Mass Index normal K/M2 observation Body_mass_index
22K2.00 Read Body Mass Index high K/M2 observation Body_mass_index
22K3.00 Read Body Mass Index low K/M2 observation Body_mass_index
22K4.00 Read Body mass index index 25-29 - overweight observation Body_mass_index
22K5.00 Read Body mass index 30+ - obesity observation Body_mass_index
22K6.00 Read Body mass index less than 20 observation Body_mass_index
22K7.00 Read Body mass index 40+ - severely obese observation Body_mass_index
22K8.00 Read Body mass index 20-24 - normal observation Body_mass_index
22Z..00 Read Height and Weight observation Body_mass_index
636..00 Read Birthweight of baby observation Body_mass_index
636..11 Read Birthweight observation Body_mass_index
636..12 Read Weight - baby observation Body_mass_index
636Z.00 Read Birthweight of baby NOS observation Body_mass_index
647..00 Read Child weight centiles observation Body_mass_index
6471.00 Read Child weight < 3rd centile observation Body_mass_index
6472.00 Read Child weight=3rd-9th centile observation Body_mass_index
6473.00 Read Child weight=10th-24th centile observation Body_mass_index
6474.00 Read Child weight=25th-49th centile observation Body_mass_index
6475.00 Read Child weight=50th-74th centile observation Body_mass_index
6476.00 Read Child weight=75th-89th centile observation Body_mass_index
6477.00 Read Child weight=90th-96th centile observation Body_mass_index
6478.00 Read Child weight > 97th centile observation Body_mass_index
6479.00 Read Child weight < 0.4th centile observation Body_mass_index
647A.00 Read Child weight = 0.4th centile observation Body_mass_index
647B.00 Read Child weight 0.5th - 1.9th centile observation Body_mass_index
647C.00 Read Child weight = 2nd centile observation Body_mass_index
647D.00 Read Child weight 3rd - 8th centile observation Body_mass_index
647E.00 Read Child weight 9th centile observation Body_mass_index
647F.00 Read Child weight 10th - 24th centile observation Body_mass_index
647G.00 Read Child weight = 25th centile observation Body_mass_index
647H.00 Read Child weight 26th - 49th centile observation Body_mass_index
647I.00 Read Child weight = 50th centile observation Body_mass_index
647J.00 Read Child weight 51st - 74th centile observation Body_mass_index
647K.00 Read Child weight = 75th centile observation Body_mass_index
647L.00 Read Child weight 76th - 90th centile observation Body_mass_index
647M.00 Read Child weight = 91st centile observation Body_mass_index
647N.00 Read Child weight 92nd - 97th centile observation Body_mass_index
647O.00 Read Child weight = 98th centile observation Body_mass_index
647P.00 Read Child weight 98.1st - 99.6th centile observation Body_mass_index
647Q.00 Read Child weight > 99.6th centile observation Body_mass_index
647Z.00 Read Child weight centiles NOS observation Body_mass_index
Q111.00 Read Premature - weight 1000g-2499g or gestation of 28-37weeks observation Body_mass_index
Q114.00 Read Low birthweight observation Body_mass_index
Q114000 Read Birth weight 1000-2499 g observation Body_mass_index
Q115.00 Read Extremely low birth weight infant observation Body_mass_index
Q115000 Read Birth weight 999 g or less observation Body_mass_index
Q120.00 Read Very large baby - weight greater than 4500gm observation Body_mass_index
L3333NA OXMIS WEIGHT ABNORMAL RANGE RECORDED observation Body_mass_index
L3333NN OXMIS WEIGHT NORMAL RANGE RECORDED observation Body_mass_index
T3324PW OXMIS PERCENTILE WEIGHT observation Body_mass_index
T3324WC OXMIS WEIGHT CHECK observation Body_mass_index
T3326BA OXMIS PERCENTILE WEIGHT OUTSIDE 5% RANGE observation Body_mass_index
T3326BC OXMIS PERCENTILE WEIGHT WITHIN 10% RANGE observation Body_mass_index
Y060 AY OXMIS SCREENING WEIGHT observation Body_mass_index
Y060 CY OXMIS SCREENING WEIGHT ABNORMAL observation Body_mass_index

1 comment has been posted.

Jan. 27, 2014, 6:18 a.m. - David Springate

Codes to identify patients meeting QOF indicator DM 2

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