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 Main outcome measures: Performance on eight clinical quality indicators withdrawn from a national incentive scheme: influenza immunisation (asthma) and lithium therapy monitoring (psychosis), removed in April 2006; blood pressure monitoring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 For five of the six indicators withdrawn in from April 2011/12, there was no significant impact on performance in that year following removal and differences between predicted and observed scores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

151 codes in list

Code Coding system Description Entity type List name smoking_status cessation_advice
137..00 Read Tobacco consumption observation smoking_status NA 0
1371.00 Read Never smoked tobacco observation smoking_status 0 0
137..11 Read Smoker - amount smoked observation smoking_status 2 0
1371.11 Read Non-smoker observation smoking_status 0 0
1372.00 Read Trivial smoker - < 1 cig/day observation smoking_status 2 0
1372.11 Read Occasional smoker observation smoking_status 2 0
1373.00 Read Light smoker - 1-9 cigs/day observation smoking_status 2 0
1374.00 Read Moderate smoker - 10-19 cigs/d observation smoking_status 2 0
1375.00 Read Heavy smoker - 20-39 cigs/day observation smoking_status 2 0
1376.00 Read Very heavy smoker - 40+cigs/d observation smoking_status 2 0
1377.00 Read Ex-trivial smoker (<1/day) observation smoking_status 1 0
1378.00 Read Ex-light smoker (1-9/day) observation smoking_status 1 0
1379.00 Read Ex-moderate smoker (10-19/day) observation smoking_status 1 0
137a.00 Read Pipe tobacco consumption observation smoking_status 2 0
137A.00 Read Ex-heavy smoker (20-39/day) observation smoking_status 1 0
137b.00 Read Ready to stop smoking observation smoking_status 2 0
137B.00 Read Ex-very heavy smoker (40+/day) observation smoking_status 1 0
137c.00 Read Thinking about stopping smoking observation smoking_status 2 0
137C.00 Read Keeps trying to stop smoking observation smoking_status 2 0
137d.00 Read Not interested in stopping smoking observation smoking_status 2 0
137D.00 Read Admitted tobacco cons untrue ? observation smoking_status 2 0
137e.00 Read Smoking restarted observation smoking_status 2 0
137E.00 Read Tobacco consumption unknown observation smoking_status NA 0
137f.00 Read Reason for restarting smoking observation smoking_status 2 0
137F.00 Read Ex-smoker - amount unknown observation smoking_status 1 0
137g.00 Read Cigarette pack-years observation smoking_status NA 0
137G.00 Read Trying to give up smoking observation smoking_status 2 0
137h.00 Read Minutes from waking to first tobacco consumption observation smoking_status 2 0
137H.00 Read Pipe smoker observation smoking_status 2 0
137I.00 Read Passive smoker observation smoking_status NA 0
137J.00 Read Cigar smoker observation smoking_status 2 0
137K.00 Read Stopped smoking observation smoking_status 1 0
137L.00 Read Current non-smoker observation smoking_status 1 0
137M.00 Read Rolls own cigarettes observation smoking_status 2 0
137N.00 Read Ex pipe smoker observation smoking_status 1 0
137O.00 Read Ex cigar smoker observation smoking_status 1 0
137P.00 Read Cigarette smoker observation smoking_status 2 0
137P.11 Read Smoker observation smoking_status 2 0
137Q.00 Read Smoking started observation smoking_status 2 0
137Q.11 Read Smoking restarted observation smoking_status 2 0
137R.00 Read Current smoker observation smoking_status 2 0
137S.00 Read Ex smoker observation smoking_status 1 0
137T.00 Read Date ceased smoking observation smoking_status 1 0
137U.00 Read Not a passive smoker observation smoking_status NA 0
137V.00 Read Smoking reduced observation smoking_status 2 0
137W.00 Read Chews tobacco observation smoking_status NA 0
137X.00 Read Cigarette consumption observation smoking_status 2 0
137Y.00 Read Cigar consumption observation smoking_status 2 0
137Z.00 Read Tobacco consumption NOS observation smoking_status 2 0
13cA.00 Read Smokes drugs observation smoking_status NA 0
13p..00 Read Smoking cessation milestones observation smoking_status NA 1
13p0.00 Read Negotiated date for cessation of smoking observation smoking_status NA 1
13p1.00 Read Smoking status at 4 weeks observation smoking_status NA 1
13p2.00 Read Smoking status between 4 and 52 weeks observation smoking_status NA 1
13p3.00 Read Smoking status at 52 weeks observation smoking_status NA 1
13p4.00 Read Smoking free weeks observation smoking_status NA 1
13p5.00 Read Smoking cessation programme start date observation smoking_status NA 1
13WF.00 Read Family smoking history observation smoking_status NA 0
13WF100 Read Father smokes observation smoking_status NA 0
13WF.11 Read Smoker in the family observation smoking_status NA 0
13WF200 Read Mother smokes observation smoking_status NA 0
13WF300 Read Both parents smoke observation smoking_status NA 0
13WF400 Read Passive smoking risk observation smoking_status NA 0
13WI.00 Read Parents do not smoke observation smoking_status NA 0
13WK.00 Read No smokers in the household observation smoking_status NA 0
177..00 Read Smoke inhalation observation smoking_status NA 0
6791.00 Read Health ed. - smoking observation smoking_status NA 1
67A3.00 Read Pregnancy smoking advice observation smoking_status NA 1
67H1.00 Read Lifestyle advice regarding smoking observation smoking_status NA 1
745H.00 Read Smoking cessation therapy observation smoking_status NA 1
745H000 Read Nicotine replacement therapy using nicotine patches observation smoking_status NA 1
745H100 Read Nicotine replacement therapy using nicotine gum observation smoking_status NA 1
745H200 Read Nicotine replacement therapy using nicotine inhalator observation smoking_status NA 1
745H300 Read Nicotine replacement therapy using nicotine lozenges observation smoking_status NA 1
8B2B.00 Read Nicotine replacement therapy observation smoking_status NA 1
8B3f.00 Read Nicotine replacement therapy provided free observation smoking_status NA 1
8B3Y.00 Read Over the counter nicotine replacement therapy observation smoking_status NA 1
8BP3.00 Read Nicotine replacement therapy provided by community pharmacis observation smoking_status NA 1
8CAg.00 Read Smoking cessation advice provided by community pharmacist observation smoking_status NA 1
8CAL.00 Read Smoking cessation advice observation smoking_status NA 1
8H7i.00 Read Referral to smoking cessation advisor observation smoking_status NA 1
8HTK.00 Read Referral to stop-smoking clinic observation smoking_status NA 1
8I2I.00 Read Nicotine replacement therapy contraindicated observation smoking_status NA 0
8I39.00 Read Nicotine replacement therapy refused observation smoking_status NA 0
8I6H.00 Read Smoking review not indicated observation smoking_status NA 0
9hG..00 Read Exception reporting: smoking quality indicators observation smoking_status NA 0
9hG0.00 Read Excepted from smoking quality indicators: Patient unsuitable observation smoking_status NA 0
9hG1.00 Read Excepted from smoking quality indicators: Informed dissent observation smoking_status NA 0
9N2k.00 Read Seen by smoking cessation advisor observation smoking_status NA 1
9N4M.00 Read DNA - Did not attend smoking cessation clinic observation smoking_status NA 1
9OO..00 Read Anti-smoking monitoring admin. observation smoking_status NA 1
9OO1.00 Read Attends stop smoking monitor. observation smoking_status NA 1
9OO..11 Read Stop smoking clinic admin. observation smoking_status NA 1
9OO..12 Read Stop smoking monitoring admin. observation smoking_status NA 1
9OO2.00 Read Refuses stop smoking monitor observation smoking_status NA 1
9OO3.00 Read Stop smoking monitor default observation smoking_status NA 1
9OO4.00 Read Stop smoking monitor 1st lettr observation smoking_status NA 1
9OO5.00 Read Stop smoking monitor 2nd lettr observation smoking_status NA 1
9OO6.00 Read Stop smoking monitor 3rd lettr observation smoking_status NA 1
9OO7.00 Read Stop smoking monitor verb.inv. observation smoking_status NA 1
9OO8.00 Read Stop smoking monitor phone inv observation smoking_status NA 1
9OO9.00 Read Stop smoking monitoring delete observation smoking_status NA 1
9OOA.00 Read Stop smoking monitor.chck done observation smoking_status NA 1
9OOZ.00 Read Stop smoking monitor admin.NOS observation smoking_status NA 0
H310100 Read Smokers' cough observation smoking_status NA 0
SM7y200 Read Smoke inhalation observation smoking_status NA 0
SM7z.11 Read Smoke inhalation observation smoking_status NA 0
ZG23300 Read Advice on smoking observation smoking_status NA 1
ZRaM.00 Read Motives for smoking scale observation smoking_status NA 1
ZRh4.00 Read Reasons for smoking scale observation smoking_status NA 1
ZRh4.11 Read RFS - Reasons for smoking scale observation smoking_status NA 1
5020M OXMIS SMOKERS' THROAT observation smoking_status NA 0
5287MK OXMIS SMOKERS' MOUTH PATCHES observation smoking_status NA 0
9879MK OXMIS SMOKE INHALATION observation smoking_status NA 0
L5090B OXMIS PARENTS BOTH SMOKE observation smoking_status NA 0
L5091S OXMIS SMOKING STARTED observation smoking_status NA 1
T509 OXMIS SMOKER observation smoking_status 2 0
T5090OR OXMIS SMOKER OWN ROLLED observation smoking_status 2 0
T5090XC OXMIS SMOKER CIGARETTES observation smoking_status 2 0
T5091 OXMIS STOPPED SMOKING observation smoking_status 1 0
T5091ES OXMIS FORMER SMOKER observation smoking_status 1 0
T5091HS OXMIS EX HEAVY SMOKER observation smoking_status 1 0
T5092 OXMIS SMOKING ADVISED TO STOP observation smoking_status 2 1
T5092S OXMIS SMOKING WISHES TO STOP observation smoking_status 2 0
T5092SA OXMIS SMOKING WANTS TO STOP observation smoking_status 2 0
T5093 OXMIS SMOKER NON observation smoking_status 1 0
T5093N OXMIS SMOKED NEVER observation smoking_status 0 0
T5094F OXMIS SMOKER IN FAMILY observation smoking_status NA 0
T5094FS OXMIS FATHER SMOKES observation smoking_status NA 0
T5094MS OXMIS MOTHER SMOKES observation smoking_status NA 0
T5094PR OXMIS PASSIVE SMOKING RISK observation smoking_status NA 0
T509 SR OXMIS SMOKING RESTARTED observation smoking_status 2 0
T510 OXMIS EXCESSIVE SMOKING observation smoking_status 2 0
T510 HS OXMIS HEAVY SMOKER (20-PLUS PER DAY) observation smoking_status 2 0
T510 SE OXMIS SMOKING EXCESSIVE observation smoking_status 2 0
T510 SH OXMIS SMOKER HEAVY (20-PLUS PER DAY) observation smoking_status 2 0
T511 OXMIS SMOKER MODERATE (LESS THAN 20 PER DAY) observation smoking_status 2 0
T5112 OXMIS SMOKER (20 PER DAY) observation smoking_status 2 0
T5113 OXMIS SMOKER (15 PER DAY) observation smoking_status 2 0
T5114 OXMIS SMOKER (10 PER DAY) observation smoking_status 2 0
T5115 OXMIS SMOKER (LESS THAN 10 PER DAY) observation smoking_status 2 0
T5115M OXMIS SMOKER MILD (5 OR LESS PER DAY) observation smoking_status 2 0
T5116 OXMIS SMOKER(OCCASIONAL) observation smoking_status 2 0
T5117 OXMIS SMOKER (30 PER DAY) observation smoking_status 2 0
T512 OXMIS SMOKER PIPE observation smoking_status 2 0
T513 OXMIS SMOKER CIGARS observation smoking_status 2 0
Y0601JJ OXMIS CLINIC ANTI-SMOKING ATTENDANCE observation smoking_status NA 1
Y0601KA OXMIS SMOKING CLINIC ATTENDANCE observation smoking_status NA 1
Y060 J1 OXMIS STOP SMOKING GROUP observation smoking_status NA 1
Y060 JJ OXMIS CLINIC ANTI-SMOKING observation smoking_status NA 1
Y060 KA OXMIS SMOKING CLINIC observation smoking_status NA 1

1 comment has been posted.

Jan. 27, 2014, 5:36 a.m. - David Springate

Codes used to identify patients meeting QOF indicators ASTHMA 4, ASTHMA 5, CHD 3, CHD 4, COPD 4, COPD 5, DM 3, DM 4, STROKE 3, STROKE 4. Smoking_status codes: 0 : Non smoker 1 : Ex smoker 2 : Current smoker

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