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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 Main outcome measures: Performance on eight clinical quality indicators withdrawn from a national incentive scheme: influenza immunisation (asthma) and lithium therapy monitoring (psychosis), removed in April 2006; blood pressure monitoring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 For five of the six indicators withdrawn in from April 2011/12, there was no significant impact on performance in that year following removal and differences between predicted and observed scores were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: Coronary_Heart_Disease
79 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| G3...00 | Read | Ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G31..00 | Read | Other acute and subacute ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G310.00 | Read | Postmyocardial infarction syndrome | diagnostic | Coronary_Heart_Disease | |||
| G310.11 | Read | Dressler's syndrome | diagnostic | Coronary_Heart_Disease | |||
| G3...11 | Read | Arteriosclerotic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G311.00 | Read | Preinfarction syndrome | diagnostic | Coronary_Heart_Disease | |||
| G311100 | Read | Unstable angina | diagnostic | Coronary_Heart_Disease | |||
| G311.11 | Read | Crescendo angina | diagnostic | Coronary_Heart_Disease | |||
| G311.12 | Read | Impending infarction | diagnostic | Coronary_Heart_Disease | |||
| G311.13 | Read | Unstable angina | diagnostic | Coronary_Heart_Disease | |||
| G311.14 | Read | Angina at rest | diagnostic | Coronary_Heart_Disease | |||
| G311200 | Read | Angina at rest | diagnostic | Coronary_Heart_Disease | |||
| G311300 | Read | Refractory angina | diagnostic | Coronary_Heart_Disease | |||
| G311500 | Read | Acute coronary syndrome | diagnostic | Coronary_Heart_Disease | |||
| G311z00 | Read | Preinfarction syndrome NOS | diagnostic | Coronary_Heart_Disease | |||
| G3...12 | Read | Atherosclerotic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G3...13 | Read | IHD - Ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G31y.00 | Read | Other acute and subacute ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G31y000 | Read | Acute coronary insufficiency | diagnostic | Coronary_Heart_Disease | |||
| G31y200 | Read | Subendocardial ischaemia | diagnostic | Coronary_Heart_Disease | |||
| G31y300 | Read | Transient myocardial ischaemia | diagnostic | Coronary_Heart_Disease | |||
| G31yz00 | Read | Other acute and subacute ischaemic heart disease NOS | diagnostic | Coronary_Heart_Disease | |||
| G32..00 | Read | Old myocardial infarction | diagnostic | Coronary_Heart_Disease | |||
| G32..11 | Read | Healed myocardial infarction | diagnostic | Coronary_Heart_Disease | |||
| G32..12 | Read | Personal history of myocardial infarction | diagnostic | Coronary_Heart_Disease | |||
| G33..00 | Read | Angina pectoris | diagnostic | Coronary_Heart_Disease | |||
| G330.00 | Read | Angina decubitus | diagnostic | Coronary_Heart_Disease | |||
| G330000 | Read | Nocturnal angina | diagnostic | Coronary_Heart_Disease | |||
| G330z00 | Read | Angina decubitus NOS | diagnostic | Coronary_Heart_Disease | |||
| G331.00 | Read | Prinzmetal's angina | diagnostic | Coronary_Heart_Disease | |||
| G331.11 | Read | Variant angina pectoris | diagnostic | Coronary_Heart_Disease | |||
| G332.00 | Read | Coronary artery spasm | diagnostic | Coronary_Heart_Disease | |||
| G33z.00 | Read | Angina pectoris NOS | diagnostic | Coronary_Heart_Disease | |||
| G33z000 | Read | Status anginosus | diagnostic | Coronary_Heart_Disease | |||
| G33z100 | Read | Stenocardia | diagnostic | Coronary_Heart_Disease | |||
| G33z200 | Read | Syncope anginosa | diagnostic | Coronary_Heart_Disease | |||
| G33z300 | Read | Angina on effort | diagnostic | Coronary_Heart_Disease | |||
| G33z400 | Read | Ischaemic chest pain | diagnostic | Coronary_Heart_Disease | |||
| G33z500 | Read | Post infarct angina | diagnostic | Coronary_Heart_Disease | |||
| G33z600 | Read | New onset angina | diagnostic | Coronary_Heart_Disease | |||
| G33z700 | Read | Stable angina | diagnostic | Coronary_Heart_Disease | |||
| G33zz00 | Read | Angina pectoris NOS | diagnostic | Coronary_Heart_Disease | |||
| G34..00 | Read | Other chronic ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G340.00 | Read | Coronary atherosclerosis | diagnostic | Coronary_Heart_Disease | |||
| G340000 | Read | Single coronary vessel disease | diagnostic | Coronary_Heart_Disease | |||
| G340100 | Read | Double coronary vessel disease | diagnostic | Coronary_Heart_Disease | |||
| G340.11 | Read | Triple vessel disease of the heart | diagnostic | Coronary_Heart_Disease | |||
| G340.12 | Read | Coronary artery disease | diagnostic | Coronary_Heart_Disease | |||
| G342.00 | Read | Atherosclerotic cardiovascular disease | diagnostic | Coronary_Heart_Disease | |||
| G343.00 | Read | Ischaemic cardiomyopathy | diagnostic | Coronary_Heart_Disease | |||
| G344.00 | Read | Silent myocardial ischaemia | diagnostic | Coronary_Heart_Disease | |||
| G34y.00 | Read | Other specified chronic ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G34y000 | Read | Chronic coronary insufficiency | diagnostic | Coronary_Heart_Disease | |||
| G34y100 | Read | Chronic myocardial ischaemia | diagnostic | Coronary_Heart_Disease | |||
| G34yz00 | Read | Other specified chronic ischaemic heart disease NOS | diagnostic | Coronary_Heart_Disease | |||
| G34z.00 | Read | Other chronic ischaemic heart disease NOS | diagnostic | Coronary_Heart_Disease | |||
| G34z000 | Read | Asymptomatic coronary heart disease | diagnostic | Coronary_Heart_Disease | |||
| G3y..00 | Read | Other specified ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| G3z..00 | Read | Ischaemic heart disease NOS | diagnostic | Coronary_Heart_Disease | |||
| Gyu3.00 | Read | [X]Ischaemic heart diseases | diagnostic | Coronary_Heart_Disease | |||
| Gyu3200 | Read | [X]Other forms of acute ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| Gyu3300 | Read | [X]Other forms of chronic ischaemic heart disease | diagnostic | Coronary_Heart_Disease | |||
| 4119B | OXMIS | ISCHAEMIC HEART DISEASE SUBACUTE | diagnostic | Coronary_Heart_Disease | |||
| 4120A | OXMIS | ISCHAEMIC HEART DISEASE HYPERTENSIVE | diagnostic | Coronary_Heart_Disease | |||
| 4129 | OXMIS | ISCHAEMIC HEART DISEASE CHRONIC | diagnostic | Coronary_Heart_Disease | |||
| 4129AN | OXMIS | ISCHAEMIC HEART DISEASE | diagnostic | Coronary_Heart_Disease | |||
| 4129N | OXMIS | ISCHAEMIC HEART DISEASE ASYMPTOMATIC | diagnostic | Coronary_Heart_Disease | |||
| 4130 | OXMIS | ANGINA PECTORIS WITH HYPERTENSION | diagnostic | Coronary_Heart_Disease | |||
| 4130E | OXMIS | ANGINA EFFORT WITH HYPERTENSION | diagnostic | Coronary_Heart_Disease | |||
| 4139 | OXMIS | ANGINA PECTORIS | diagnostic | Coronary_Heart_Disease | |||
| 4139AT | OXMIS | ANGINA ATYPICAL | diagnostic | Coronary_Heart_Disease | |||
| 4139C | OXMIS | CARDIAC ANGINA | diagnostic | Coronary_Heart_Disease | |||
| 4139CO | OXMIS | ANGINA CRESCENDO | diagnostic | Coronary_Heart_Disease | |||
| 4139E | OXMIS | ANGINA EFFORT | diagnostic | Coronary_Heart_Disease | |||
| 4139M | OXMIS | SYNDROME ANGINAL | diagnostic | Coronary_Heart_Disease | |||
| 4139N | OXMIS | ANGINA | diagnostic | Coronary_Heart_Disease | |||
| 4139PA | OXMIS | ANGINA INVERSA | diagnostic | Coronary_Heart_Disease | |||
| 4139U | OXMIS | UNSTABLE ANGINA | diagnostic | Coronary_Heart_Disease | |||
| 4149 | OXMIS | ASYMPTOMATIC ISCHAEMIC HEART DISEASE | diagnostic | Coronary_Heart_Disease |
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Codes used to identify patients with CHD. CHD treated as a chronic condition. Patients with any codes from this list prior to the end of a given QOF year are included for that year.