Code list: HbA1C

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 Main outcome measures: Performance on eight clinical quality indicators withdrawn from a national incentive scheme: influenza immunisation (asthma) and lithium therapy monitoring (psychosis), removed in April 2006; blood pressure monitoring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 For five of the six indicators withdrawn in from April 2011/12, there was no significant impact on performance in that year following removal and differences between predicted and observed scores were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: HbA1C_testing

23 codes in list

Code	Coding system	Description	Entity type	List name
42c..00	Read	HbA1 - diabetic control	test	HbA1C_testing
42c0.00	Read	HbA1 < 7% - good control	test	HbA1C_testing
42c1.00	Read	HbA1 7 - 10% - borderline control	test	HbA1C_testing
42c2.00	Read	HbA1 > 10% - bad control	test	HbA1C_testing
42c3.00	Read	HbA1 level (DCCT aligned)	test	HbA1C_testing
42W..00	Read	Hb. A1C - diabetic control	test	HbA1C_testing
42W1.00	Read	Hb. A1C < 7% - good control	test	HbA1C_testing
42W..11	Read	Glycosylated Hb	test	HbA1C_testing
42W..12	Read	Glycated haemoglobin	test	HbA1C_testing
42W2.00	Read	Hb. A1C 7-10% - borderline	test	HbA1C_testing
42W3.00	Read	Hb. A1C > 10% - bad control	test	HbA1C_testing
42W4.00	Read	HbA1c level (DCCT aligned)	test	HbA1C_testing
44TB.00	Read	Haemoglobin A1c level	test	HbA1C_testing
44TC.00	Read	Haemoglobin A1 level	test	HbA1C_testing
44TD.00	Read	Fructosamine level	test	HbA1C_testing
44TL.00	Read	Total glycosylated haemoglobin level	test	HbA1C_testing
44Z1.00	Read	Serum fructosamine	test	HbA1C_testing
44Z1000	Read	Corrected fructosamine	test	HbA1C_testing
2718PA	OXMIS	FRUCTOSAMINE	test	HbA1C_testing
L2859G	OXMIS	Hb A1C (GLYCOSYLATED HAEMOGLOBIN TEST)	test	HbA1C_testing
L2859GA	OXMIS	Hb A1C NORMAL (GLYCOSYLATED HAEMOGLOBIN	test	HbA1C_testing
L2859GB	OXMIS	Hb A1C HIGH (GLYCOSYLATED HAEMOGLOBIN TE	test	HbA1C_testing
L9027F	OXMIS	SERUM FRUCTOSAMINE LEVEL	test	HbA1C_testing

1 comment has been posted.

Jan. 27, 2014, 7:10 a.m. - David Springate: QOF indicators DM 5, Dm 6, DM 7

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