Code list: exercise

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 Main outcome measures: Performance on eight clinical quality indicators withdrawn from a national incentive scheme: influenza immunisation (asthma) and lithium therapy monitoring (psychosis), removed in April 2006; blood pressure monitoring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 For five of the six indicators withdrawn in from April 2011/12, there was no significant impact on performance in that year following removal and differences between predicted and observed scores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

18 codes in list

Code	Coding system	Description	Entity type	List name
3213.00	Read	Exercise ECG	test	exercise_testing
3213000	Read	Exercise ECG normal	test	exercise_testing
3213011	Read	Negative exercise ECG test	test	exercise_testing
3213100	Read	Exercise ECG abnormal	test	exercise_testing
3213111	Read	Positive exercise ECG test	test	exercise_testing
33B9.00	Read	Exercise tolerance test	test	exercise_testing
33B9100	Read	Exercise tolerance test done	test	exercise_testing
33B9300	Read	Exercise tolerance test normal	test	exercise_testing
33B9400	Read	Exercise toler test equivocal	test	exercise_testing
33B9500	Read	Exercise tolerance test abnormal	test	exercise_testing
33B9Z00	Read	Exercise tolerance test NOS	test	exercise_testing
5744.00	Read	Isotope dynamic heart scan	test	exercise_testing
8H44.00	Read	Cardiological referral	test	exercise_testing
8H4R.00	Read	Referral to cardiology special interest general practitioner	test	exercise_testing
8HRA.00	Read	Referral for exercise ECG	test	exercise_testing
8HTJ.00	Read	Referral to rapid access chest pain clinic	test	exercise_testing
8HVJ.00	Read	Private referral to cardiologist	test	exercise_testing
9N0f.00	Read	Seen in rapid access chest pain clinic	test	exercise_testing

1 comment has been posted.

Jan. 27, 2014, 5:54 a.m. - David Springate: Codes used to identify patients meeting QOF indicator CHD 2

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