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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 Main outcome measures: Performance on eight clinical quality indicators withdrawn from a national incentive scheme: influenza immunisation (asthma) and lithium therapy monitoring (psychosis), removed in April 2006; blood pressure monitoring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 For five of the six indicators withdrawn in from April 2011/12, there was no significant impact on performance in that year following removal and differences between predicted and observed scores were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: Thyroid_function
82 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 442..00 | Read | Thyroid hormone tests | diagnostic | Thyroid_function | |||
| 4421.00 | Read | Thyroid hormone tests normal | diagnostic | Thyroid_function | |||
| 442..11 | Read | TRH level | diagnostic | Thyroid_function | |||
| 4421.11 | Read | Euthyroid | diagnostic | Thyroid_function | |||
| 442..12 | Read | TSH level | diagnostic | Thyroid_function | |||
| 442..13 | Read | Thyroid function tests | diagnostic | Thyroid_function | |||
| 442..14 | Read | Thyroxine binding globulin | diagnostic | Thyroid_function | |||
| 4422.00 | Read | Thyroid hormone tests high | diagnostic | Thyroid_function | |||
| 4423.00 | Read | Thyroid hormone tests low | diagnostic | Thyroid_function | |||
| 4424.00 | Read | Serum T3 level | diagnostic | Thyroid_function | |||
| 4424000 | Read | Serum T3 level normal | diagnostic | Thyroid_function | |||
| 4424100 | Read | Serum T3 level high | diagnostic | Thyroid_function | |||
| 4424200 | Read | Serum T3 level low | diagnostic | Thyroid_function | |||
| 4425.00 | Read | Free T3 level | diagnostic | Thyroid_function | |||
| 4426.00 | Read | Serum T4 level | diagnostic | Thyroid_function | |||
| 4426000 | Read | Serum T4 level normal | diagnostic | Thyroid_function | |||
| 4426100 | Read | Serum T4 level abnormal | diagnostic | Thyroid_function | |||
| 4427.00 | Read | Free T4 level | diagnostic | Thyroid_function | |||
| 4428.00 | Read | Free thyroxine index | diagnostic | Thyroid_function | |||
| 4429.00 | Read | Thyroxine binding globulin-TBG | diagnostic | Thyroid_function | |||
| 442a.00 | Read | Plasma total T4 level | diagnostic | Thyroid_function | |||
| 442A.00 | Read | TSH - thyroid stim. hormone | diagnostic | Thyroid_function | |||
| 442A000 | Read | Serum TSH level normal | diagnostic | Thyroid_function | |||
| 442A100 | Read | Serum TSH level abnormal | diagnostic | Thyroid_function | |||
| 442b.00 | Read | Serum total T4 level | diagnostic | Thyroid_function | |||
| 442B.00 | Read | TRH - thyroid release. hormone | diagnostic | Thyroid_function | |||
| 442c.00 | Read | Plasma free T4 level | diagnostic | Thyroid_function | |||
| 442C.00 | Read | Thyroid horm tests borderline | diagnostic | Thyroid_function | |||
| 442d.00 | Read | Serum thyroglobulin level | diagnostic | Thyroid_function | |||
| 442D.00 | Read | T3 uptake test | diagnostic | Thyroid_function | |||
| 442D000 | Read | T3 uptake test normal | diagnostic | Thyroid_function | |||
| 442D100 | Read | T3 uptake test abnormal | diagnostic | Thyroid_function | |||
| 442e.00 | Read | Blood spot TSH level | diagnostic | Thyroid_function | |||
| 442E.00 | Read | PBI - protein bound iodine estimation | diagnostic | Thyroid_function | |||
| 442f.00 | Read | Serum total T3 level | diagnostic | Thyroid_function | |||
| 442F.00 | Read | T3 suppression test | diagnostic | Thyroid_function | |||
| 442g.00 | Read | Serum thyroglobulin recovery level | diagnostic | Thyroid_function | |||
| 442G.00 | Read | Thyroid hormone tests abnormal | diagnostic | Thyroid_function | |||
| 442H.00 | Read | Thyroid function tests normal | diagnostic | Thyroid_function | |||
| 442I.00 | Read | Thyroid function tests abnormal | diagnostic | Thyroid_function | |||
| 442J.00 | Read | Thyroid function test | diagnostic | Thyroid_function | |||
| 442K.00 | Read | 30 minute plasma TSH level | diagnostic | Thyroid_function | |||
| 442L.00 | Read | 60 minute plasma TSH level | diagnostic | Thyroid_function | |||
| 442M.00 | Read | 90 minute plasma TSH level | diagnostic | Thyroid_function | |||
| 442N.00 | Read | 120 minute plasma TSH level | diagnostic | Thyroid_function | |||
| 442O.00 | Read | 150 minute plasma TSH level | diagnostic | Thyroid_function | |||
| 442P.00 | Read | 30 minute serum TSH level | diagnostic | Thyroid_function | |||
| 442Q.00 | Read | 60 minute serum TSH level | diagnostic | Thyroid_function | |||
| 442S.00 | Read | 120 minute serum TSH level | diagnostic | Thyroid_function | |||
| 442T.00 | Read | 150 minute serum TSH level | diagnostic | Thyroid_function | |||
| 442U.00 | Read | Serum free triiodothyronine level | diagnostic | Thyroid_function | |||
| 442V.00 | Read | Serum free T4 level | diagnostic | Thyroid_function | |||
| 442W.00 | Read | Serum TSH level | diagnostic | Thyroid_function | |||
| 442X.00 | Read | Plasma TSH level | diagnostic | Thyroid_function | |||
| 442Y.00 | Read | Plasma free triiodothyronine level | diagnostic | Thyroid_function | |||
| 442Z.00 | Read | Thyroid hormone tests NOS | diagnostic | Thyroid_function | |||
| R145.00 | Read | [D]Thyroid function test abnormal | diagnostic | Thyroid_function | |||
| R145z00 | Read | [D]Thyroid function tests abnormal NOS | diagnostic | Thyroid_function | |||
| L 112MA | OXMIS | SERUM TSH | diagnostic | Thyroid_function | |||
| L 112MB | OXMIS | SERUM TSH NORMAL | diagnostic | Thyroid_function | |||
| L 112MC | OXMIS | SERUM TSH ABNORMAL | diagnostic | Thyroid_function | |||
| L 112N | OXMIS | TSH LEVEL | diagnostic | Thyroid_function | |||
| L 112NB | OXMIS | TSH LEVEL NORMAL | diagnostic | Thyroid_function | |||
| L 112NC | OXMIS | TSH LEVEL ABNORMAL | diagnostic | Thyroid_function | |||
| L4000T | OXMIS | SERUM THYROXINE LEVEL | diagnostic | Thyroid_function | |||
| L4000TE | OXMIS | THYROXINE ESTIMATION | diagnostic | Thyroid_function | |||
| L4021L | OXMIS | T4 LEVEL | diagnostic | Thyroid_function | |||
| L4021LA | OXMIS | T4 LEVEL ABNORMAL | diagnostic | Thyroid_function | |||
| L4021LN | OXMIS | T4 LEVEL NORMAL | diagnostic | Thyroid_function | |||
| L4021PA | OXMIS | T4 TOXICOSIS TEST ABNORMAL | diagnostic | Thyroid_function | |||
| L4021PN | OXMIS | T4 TOXICOSIS TEST NORMAL | diagnostic | Thyroid_function | |||
| L4021PV | OXMIS | T4 TOXICOSIS TEST | diagnostic | Thyroid_function | |||
| L4031 | OXMIS | T3 UPTAKE TEST | diagnostic | Thyroid_function | |||
| L4031AA | OXMIS | T3 UPTAKE TEST ABNORMAL | diagnostic | Thyroid_function | |||
| L4031AN | OXMIS | T3 UPTAKE TEST NORMAL | diagnostic | Thyroid_function | |||
| L4031HS | OXMIS | T3 SERUM LEVEL INCREASED | diagnostic | Thyroid_function | |||
| L4031LF | OXMIS | T3 FREE LEVEL | diagnostic | Thyroid_function | |||
| L4031LS | OXMIS | T3 SERUM LEVEL DECREASED | diagnostic | Thyroid_function | |||
| L4031NM | OXMIS | T3 LEVEL | diagnostic | Thyroid_function | |||
| L4033F | OXMIS | THYROID FUNCTION TEST | diagnostic | Thyroid_function | |||
| L4033FA | OXMIS | THYROID FUNCTION TEST ABNORMAL | diagnostic | Thyroid_function | |||
| L4033FN | OXMIS | THYROID FUNCTION TEST NORMAL | diagnostic | Thyroid_function |
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To be used with codelist [serum_creatine_testing] to define QOF indicator MH 4 (severe mental health)