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 Main outcome measures: Performance on eight clinical quality indicators withdrawn from a national incentive scheme: influenza immunisation (asthma) and lithium therapy monitoring (psychosis), removed in April 2006; blood pressure monitoring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 For five of the six indicators withdrawn in from April 2011/12, there was no significant impact on performance in that year following removal and differences between predicted and observed scores were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: Retinal_screening
67 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 2BB..00 | Read | O/E - retinal inspection | test | Retinal_screening | |||
| 2BB1.00 | Read | O/E - retina normal | test | Retinal_screening | |||
| 2BB..11 | Read | O/E - retina | test | Retinal_screening | |||
| 2BB2.00 | Read | O/E - retinal vessel narrowing | test | Retinal_screening | |||
| 2BB3.00 | Read | O/E - retinal A-V nipping | test | Retinal_screening | |||
| 2BB4.00 | Read | O/E - retinal microaneurysms | test | Retinal_screening | |||
| 2BB5.00 | Read | O/E - retinal haemorrhages | test | Retinal_screening | |||
| 2BB6.00 | Read | O/E - retinal exudates | test | Retinal_screening | |||
| 2BB7.00 | Read | O/E - retinal vascular prolif. | test | Retinal_screening | |||
| 2BB8.00 | Read | O/E - vitreous haemorrhages | test | Retinal_screening | |||
| 2BB9.00 | Read | O/E - retinal pigmentation | test | Retinal_screening | |||
| 2BBa.00 | Read | O/E- non-referable retinopathy | test | Retinal_screening | |||
| 2BBA.00 | Read | Examination of retina | test | Retinal_screening | |||
| 2BBb.00 | Read | O/E - fundus not adequately seen | test | Retinal_screening | |||
| 2BBB.00 | Read | O/E - Right retina not seen | test | Retinal_screening | |||
| 2BBc.00 | Read | O/E - No retinal laser photocoagulation scars | test | Retinal_screening | |||
| 2BBC.00 | Read | O/E - Left retina not seen | test | Retinal_screening | |||
| 2BBd.00 | Read | O/E - Red reflex absent | test | Retinal_screening | |||
| 2BBD.00 | Read | O/E - Right retina normal | test | Retinal_screening | |||
| 2BBe.00 | Read | O/E - right retina partially assessable | test | Retinal_screening | |||
| 2BBE.00 | Read | O/E - Left retina normal | test | Retinal_screening | |||
| 2BBF.00 | Read | Retinal abnormality - diabetes related | test | Retinal_screening | |||
| 2BBg.00 | Read | O/E - right retina fully assessable | test | Retinal_screening | |||
| 2BBG.00 | Read | Retinal abnormality - non-diabetes | test | Retinal_screening | |||
| 2BBH.00 | Read | Retinal drusen | test | Retinal_screening | |||
| 2BBi.00 | Read | O/E - right eye no maculopathy | test | Retinal_screening | |||
| 2BBI.00 | Read | O/E - no retinopathy | test | Retinal_screening | |||
| 2BBj.00 | Read | O/E - left eye no maculopathy | test | Retinal_screening | |||
| 2BBJ.00 | Read | O/E - no right diabetic retinopathy | test | Retinal_screening | |||
| 2BBk.00 | Read | O/E - right eye stable treated prolif diabetic retinopathy | test | Retinal_screening | |||
| 2BBK.00 | Read | O/E - no left diabetic retinopathy | test | Retinal_screening | |||
| 2BBl.00 | Read | O/E - left eye stable treated prolif diabetic retinopathy | test | Retinal_screening | |||
| 2BBL.00 | Read | O/E - diabetic maculopathy present both eyes | test | Retinal_screening | |||
| 2BBm.00 | Read | O/E - right eye clinically significant macular oedema | test | Retinal_screening | |||
| 2BBM.00 | Read | O/E - diabetic maculopathy absent both eyes | test | Retinal_screening | |||
| 2BBn.00 | Read | O/E - left eye clinically significant macular oedema | test | Retinal_screening | |||
| 2BBN.00 | Read | Myelinated retinal nerve fibres | test | Retinal_screening | |||
| 2BBo.00 | Read | O/E - sight threatening diabetic retinopathy | test | Retinal_screening | |||
| 2BBO.00 | Read | O/E - Laser photocoagulation scars | test | Retinal_screening | |||
| 2BBP.00 | Read | O/E - right eye background diabetic retinopathy | test | Retinal_screening | |||
| 2BBQ.00 | Read | O/E - left eye background diabetic retinopathy | test | Retinal_screening | |||
| 2BBR.00 | Read | O/E - right eye preproliferative diabetic retinopathy | test | Retinal_screening | |||
| 2BBS.00 | Read | O/E - left eye preproliferative diabetic retinopathy | test | Retinal_screening | |||
| 2BBT.00 | Read | O/E - right eye proliferative diabetic retinopathy | test | Retinal_screening | |||
| 2BBV.00 | Read | O/E - left eye proliferative diabetic retinopathy | test | Retinal_screening | |||
| 2BBW.00 | Read | O/E - right eye diabetic maculopathy | test | Retinal_screening | |||
| 2BBX.00 | Read | O/E - left eye diabetic maculopathy | test | Retinal_screening | |||
| 2BBY.00 | Read | O/E - referable retinopathy | test | Retinal_screening | |||
| 2BBZ.00 | Read | O/E - retinal inspection NOS | test | Retinal_screening | |||
| 3128.00 | Read | Fundoscopy | test | Retinal_screening | |||
| 3128000 | Read | Fundoscopy normal | test | Retinal_screening | |||
| 3128100 | Read | Fundoscopy abnormal | test | Retinal_screening | |||
| 3128.11 | Read | Retinoscopy | test | Retinal_screening | |||
| 3128200 | Read | Dilated fundoscopy normal | test | Retinal_screening | |||
| 3128300 | Read | Camera fundoscopy | test | Retinal_screening | |||
| 3128400 | Read | Indirect fundoscopy following mydriatic | test | Retinal_screening | |||
| 3128Z00 | Read | Fundoscopy NOS | test | Retinal_screening | |||
| 3129.00 | Read | Eye fundus photography | test | Retinal_screening | |||
| 312E.00 | Read | Direct fundoscopy following mydriatic | test | Retinal_screening | |||
| 312G.00 | Read | Indirect fundoscopy following mydriatic | test | Retinal_screening | |||
| 58C1.00 | Read | Retinal photography | test | Retinal_screening | |||
| 66AD.00 | Read | Fundoscopy - diabetic check | test | Retinal_screening | |||
| 68A7.00 | Read | Diabetic retinopathy screening | test | Retinal_screening | |||
| 68A8.00 | Read | Digital retinal screening | test | Retinal_screening | |||
| X962 | OXMIS | FUNDOSCOPY | test | Retinal_screening | |||
| X962 AB | OXMIS | FUNDOSCOPY ABNORMAL | test | Retinal_screening | |||
| X962 NM | OXMIS | FUNDOSCOPY NORMAL | test | Retinal_screening |
Please log in to leave a comment.
Code list links:
ClinicalCodes is a project at the University of Manchester Institute of Population Health
The ClinicalCodes project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR)
QOF indicator DM 8