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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 Main outcome measures: Performance on eight clinical quality indicators withdrawn from a national incentive scheme: influenza immunisation (asthma) and lithium therapy monitoring (psychosis), removed in April 2006; blood pressure monitoring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 For five of the six indicators withdrawn in from April 2011/12, there was no significant impact on performance in that year following removal and differences between predicted and observed scores were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: Stroke
84 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| G61..00 | Read | Intracerebral haemorrhage | diagnostic | Stroke | |||
| G610.00 | Read | Cortical haemorrhage | diagnostic | Stroke | |||
| G611.00 | Read | Internal capsule haemorrhage | diagnostic | Stroke | |||
| G61..11 | Read | CVA - cerebrovascular accid due to intracerebral haemorrhage | diagnostic | Stroke | |||
| G61..12 | Read | Stroke due to intracerebral haemorrhage | diagnostic | Stroke | |||
| G612.00 | Read | Basal nucleus haemorrhage | diagnostic | Stroke | |||
| G613.00 | Read | Cerebellar haemorrhage | diagnostic | Stroke | |||
| G614.00 | Read | Pontine haemorrhage | diagnostic | Stroke | |||
| G615.00 | Read | Bulbar haemorrhage | diagnostic | Stroke | |||
| G616.00 | Read | External capsule haemorrhage | diagnostic | Stroke | |||
| G618.00 | Read | Intracerebral haemorrhage; multiple localized | diagnostic | Stroke | |||
| G61X.00 | Read | Intracerebral haemorrhage in hemisphere; unspecified | diagnostic | Stroke | |||
| G61X000 | Read | Left sided intracerebral haemorrhage; unspecified | diagnostic | Stroke | |||
| G61X100 | Read | Right sided intracerebral haemorrhage; unspecified | diagnostic | Stroke | |||
| G61z.00 | Read | Intracerebral haemorrhage NOS | diagnostic | Stroke | |||
| G63y000 | Read | Cerebral infarct due to thrombosis of precerebral arteries | diagnostic | Stroke | |||
| G63y100 | Read | Cerebral infarction due to embolism of precerebral arteries | diagnostic | Stroke | |||
| G64..00 | Read | Cerebral arterial occlusion | diagnostic | Stroke | |||
| G640.00 | Read | Cerebral thrombosis | diagnostic | Stroke | |||
| G640000 | Read | Cerebral infarction due to thrombosis of cerebral arteries | diagnostic | Stroke | |||
| G641.00 | Read | Cerebral embolism | diagnostic | Stroke | |||
| G641000 | Read | Cerebral infarction due to embolism of cerebral arteries | diagnostic | Stroke | |||
| G64..11 | Read | CVA - cerebral artery occlusion | diagnostic | Stroke | |||
| G641.11 | Read | Cerebral embolus | diagnostic | Stroke | |||
| G64..12 | Read | Infarction - cerebral | diagnostic | Stroke | |||
| G64..13 | Read | Stroke due to cerebral arterial occlusion | diagnostic | Stroke | |||
| G64z.00 | Read | Cerebral infarction NOS | diagnostic | Stroke | |||
| G64z000 | Read | Brainstem infarction | diagnostic | Stroke | |||
| G64z100 | Read | Wallenberg syndrome | diagnostic | Stroke | |||
| G64z.11 | Read | Brainstem infarction NOS | diagnostic | Stroke | |||
| G64z111 | Read | Lateral medullary syndrome | diagnostic | Stroke | |||
| G64z.12 | Read | Cerebellar infarction | diagnostic | Stroke | |||
| G64z200 | Read | Left sided cerebral infarction | diagnostic | Stroke | |||
| G64z300 | Read | Right sided cerebral infarction | diagnostic | Stroke | |||
| G64z400 | Read | Infarction of basal ganglia | diagnostic | Stroke | |||
| G65..00 | Read | Transient cerebral ischaemia | diagnostic | Stroke | |||
| G650.00 | Read | Basilar artery syndrome | diagnostic | Stroke | |||
| G650.11 | Read | Insufficiency - basilar artery | diagnostic | Stroke | |||
| G651.00 | Read | Vertebral artery syndrome | diagnostic | Stroke | |||
| G651000 | Read | Vertebro-basilar artery syndrome | diagnostic | Stroke | |||
| G65..11 | Read | Drop attack | diagnostic | Stroke | |||
| G65..12 | Read | Transient ischaemic attack | diagnostic | Stroke | |||
| G65..13 | Read | Vertebro-basilar insufficiency | diagnostic | Stroke | |||
| G652.00 | Read | Subclavian steal syndrome | diagnostic | Stroke | |||
| G653.00 | Read | Carotid artery syndrome hemispheric | diagnostic | Stroke | |||
| G654.00 | Read | Multiple and bilateral precerebral artery syndromes | diagnostic | Stroke | |||
| G656.00 | Read | Vertebrobasilar insufficiency | diagnostic | Stroke | |||
| G65y.00 | Read | Other transient cerebral ischaemia | diagnostic | Stroke | |||
| G65z.00 | Read | Transient cerebral ischaemia NOS | diagnostic | Stroke | |||
| G65z000 | Read | Impending cerebral ischaemia | diagnostic | Stroke | |||
| G65z100 | Read | Intermittent cerebral ischaemia | diagnostic | Stroke | |||
| G65zz00 | Read | Transient cerebral ischaemia NOS | diagnostic | Stroke | |||
| G66..00 | Read | Stroke and cerebrovascular accident unspecified | diagnostic | Stroke | |||
| G660.00 | Read | Middle cerebral artery syndrome | diagnostic | Stroke | |||
| G661.00 | Read | Anterior cerebral artery syndrome | diagnostic | Stroke | |||
| G66..11 | Read | CVA unspecified | diagnostic | Stroke | |||
| G66..12 | Read | Stroke unspecified | diagnostic | Stroke | |||
| G66..13 | Read | CVA - Cerebrovascular accident unspecified | diagnostic | Stroke | |||
| G662.00 | Read | Posterior cerebral artery syndrome | diagnostic | Stroke | |||
| G663.00 | Read | Brain stem stroke syndrome | diagnostic | Stroke | |||
| G664.00 | Read | Cerebellar stroke syndrome | diagnostic | Stroke | |||
| G665.00 | Read | Pure motor lacunar syndrome | diagnostic | Stroke | |||
| G666.00 | Read | Pure sensory lacunar syndrome | diagnostic | Stroke | |||
| G667.00 | Read | Left sided CVA | diagnostic | Stroke | |||
| G668.00 | Read | Right sided CVA | diagnostic | Stroke | |||
| G6W..00 | Read | Cereb infarct due unsp occlus/stenos precerebr arteries | diagnostic | Stroke | |||
| G6X..00 | Read | Cerebrl infarctn due/unspcf occlusn or sten/cerebrl artrs | diagnostic | Stroke | |||
| Gyu6200 | Read | [X]Other intracerebral haemorrhage | diagnostic | Stroke | |||
| Gyu6300 | Read | [X]Cerebrl infarctn due/unspcf occlusn or sten/cerebrl artrs | diagnostic | Stroke | |||
| Gyu6400 | Read | [X]Other cerebral infarction | diagnostic | Stroke | |||
| Gyu6500 | Read | [X]Occlusion and stenosis of other precerebral arteries | diagnostic | Stroke | |||
| Gyu6600 | Read | [X]Occlusion and stenosis of other cerebral arteries | diagnostic | Stroke | |||
| Gyu6G00 | Read | [X]Cereb infarct due unsp occlus/stenos precerebr arteries | diagnostic | Stroke | |||
| L440.11 | Read | CVA - cerebrovascular accident in the puerperium | diagnostic | Stroke | |||
| L440.12 | Read | Stroke in the puerperium | diagnostic | Stroke | |||
| 4350AT | OXMIS | TRANSIENT ISCHAEMIC ATTACKS WITH HYPERTE | diagnostic | Stroke | |||
| 4359AT | OXMIS | TRANSIENT ISCHAEMIC ATTACKS | diagnostic | Stroke | |||
| 4360A | OXMIS | CEREBROVASCULAR ACCIDENT WITH HYPERTENSI | diagnostic | Stroke | |||
| 4360B | OXMIS | STROKE WITH HYPERTENSION | diagnostic | Stroke | |||
| 4369A | OXMIS | CVA (CEREBROVASCULAR ACCIDENT) | diagnostic | Stroke | |||
| 4369AL | OXMIS | CEREBROVASCULAR ACCIDENT LEFT | diagnostic | Stroke | |||
| 4369AR | OXMIS | CEREBROVASCULAR ACCIDENT RIGHT | diagnostic | Stroke | |||
| 4369B | OXMIS | STROKE | diagnostic | Stroke | |||
| 4369BN | OXMIS | SYNDROME STROKE | diagnostic | Stroke |
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Codes used to identify Stroke patients. Stroke 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.