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Research article:
Effect of financial incentives on incentivised and non-incentivised clinical activities: longitudinal analysis of data from the UK Quality and Outcomes Framework
Reference:
Doran, Tim; Kontopantelis, Evangelos; Valderas, Jose M; Campbell, Stephen; Roland, Martin; Salisbury, Chris; Reeves, David(2011) Effect of financial incentives on incentivised and non-incentivised clinical activities: longitudinal analysis of data from the UK Quality and Outcomes Framework. British Medical Journal, doi: 10.1136/bmj.d3590
- Link to fulltext article
- Abstract
- Objective: To investigate whether the incentive scheme for UK general practitioners led them to neglect activities not included in the scheme. Design: Longitudinal analysis of achievement rates for 42 activities (23 included in incentive scheme, 19 not included) selected from 428 identified indicators of quality of care. Setting: 148 general practices in England (653 500 patients). Main outcome measures: Achievement rates projected from trends in the pre-incentive period (2000-1 to 2002-3) and actual rates in the first three years of the scheme (2004-5 to 2006-7). Results: Achievement rates improved for most indicators in the pre-incentive period. There were significant increases in the rate of improvement in the first year of the incentive scheme (2004-5) for 22 of the 23 incentivised indicators. Achievement for these indicators reached a plateau after 2004-5, but quality of care in 2006-7 remained higher than that predicted by pre-incentive trends for 14 incentivised indicators. There was no overall effect on the rate of improvement for non-incentivised indicators in the first year of the scheme, but by 2006-7 achievement rates were significantly below those predicted by pre-incentive trends. Conclusions: There were substantial improvements in quality for all indicators between 2001 and 2007. Improvements associated with financial incentives seem to have been achieved at the expense of small detrimental effects on aspects of care that were not incentivised.
- Author for correspondence
- Tim Doran
- Email for correspondence
- tim.doran@york.ac.uk
Code list: asthma
197 codes in list
| Code | Coding system | Description | Entity type | List name | QOF | analysis | |
|---|---|---|---|---|---|---|---|
| 173A.00 | Read | Exercise induced asthma | diagnostic | asthma | 0 | Main | |
| 173c.00 | Read | Occupational asthma | diagnostic | asthma | 0 | Main | |
| 173d.00 | Read | Work aggravated asthma | diagnostic | asthma | 0 | Main | |
| 178..00 | Read | Asthma trigger | diagnostic | asthma | 0 | Sensitivity | |
| 1780.00 | Read | Aspirin induced asthma | diagnostic | asthma | 0 | Main | |
| 1O2..00 | Read | Asthma confirmed | diagnostic | asthma | 0 | Main | |
| 2126200 | Read | Asthma resolved | diagnostic | asthma | -1 | Resolve | |
| 212G.00 | Read | Asthma resolved | diagnostic | asthma | -1 | Resolve | |
| 663..11 | Read | Asthma monitoring | diagnostic | asthma | 0 | Sensitivity | |
| 663d.00 | Read | Emergency asthma admission since last appointment | diagnostic | asthma | 0 | Sensitivity | |
| 663e.00 | Read | Asthma restricts exercise | diagnostic | asthma | 0 | Sensitivity | |
| 663e000 | Read | Asthma sometimes restricts exercise | diagnostic | asthma | 0 | Sensitivity | |
| 663e100 | Read | Asthma severely restricts exercise | diagnostic | asthma | 0 | Sensitivity | |
| 663f.00 | Read | Asthma never restricts exercise | diagnostic | asthma | 0 | Sensitivity | |
| 663h.00 | Read | Asthma - currently dormant | diagnostic | asthma | 0 | Sensitivity | |
| 663j.00 | Read | Asthma - currently active | diagnostic | asthma | 0 | Main | |
| 663m.00 | Read | Asthma accident and emergency attendance since last visit | diagnostic | asthma | 0 | Sensitivity | |
| 663n.00 | Read | Asthma treatment compliance satisfactory | diagnostic | asthma | 0 | Sensitivity | |
| 663N.00 | Read | Asthma disturbing sleep | diagnostic | asthma | 0 | Sensitivity | |
| 663N000 | Read | Asthma causing night waking | diagnostic | asthma | 0 | Sensitivity | |
| 663N100 | Read | Asthma disturbs sleep weekly | diagnostic | asthma | 0 | Sensitivity | |
| 663N200 | Read | Asthma disturbs sleep frequently | diagnostic | asthma | 0 | Sensitivity | |
| 663O.00 | Read | Asthma not disturbing sleep | diagnostic | asthma | 0 | Sensitivity | |
| 663O000 | Read | Asthma never disturbs sleep | diagnostic | asthma | 0 | Sensitivity | |
| 663p.00 | Read | Asthma treatment compliance unsatisfactory | diagnostic | asthma | 0 | Sensitivity | |
| 663P.00 | Read | Asthma limiting activities | diagnostic | asthma | 0 | Sensitivity | |
| 663q.00 | Read | Asthma daytime symptoms | diagnostic | asthma | 0 | Sensitivity | |
| 663Q.00 | Read | Asthma not limiting activities | diagnostic | asthma | 0 | Sensitivity | |
| 663r.00 | Read | Asthma causes night symptoms 1 to 2 times per month | diagnostic | asthma | 0 | Sensitivity | |
| 663s.00 | Read | Asthma never causes daytime symptoms | diagnostic | asthma | 0 | Sensitivity | |
| 663t.00 | Read | Asthma causes daytime symptoms 1 to 2 times per month | diagnostic | asthma | 0 | Sensitivity | |
| 663u.00 | Read | Asthma causes daytime symptoms 1 to 2 times per week | diagnostic | asthma | 0 | Sensitivity | |
| 663U.00 | Read | Asthma management plan given | diagnostic | asthma | 0 | Sensitivity | |
| 663v.00 | Read | Asthma causes daytime symptoms most days | diagnostic | asthma | 0 | Sensitivity | |
| 663V.00 | Read | Asthma severity | diagnostic | asthma | 0 | Sensitivity | |
| 663V000 | Read | Occasional asthma | diagnostic | asthma | 0 | Main | |
| 663V100 | Read | Mild asthma | diagnostic | asthma | 0 | Main | |
| 663V200 | Read | Moderate asthma | diagnostic | asthma | 0 | Main | |
| 663V300 | Read | Severe asthma | diagnostic | asthma | 0 | Main | |
| 663w.00 | Read | Asthma limits walking up hills or stairs | diagnostic | asthma | 0 | Sensitivity | |
| 663W.00 | Read | Asthma prophylactic medication used | diagnostic | asthma | 0 | Sensitivity | |
| 663x.00 | Read | Asthma limits walking on the flat | diagnostic | asthma | 0 | Sensitivity | |
| 663y.00 | Read | Number of asthma exacerbations in past year | diagnostic | asthma | 0 | Sensitivity | |
| 66Y5.00 | Read | Change in asthma management plan | diagnostic | asthma | 0 | Sensitivity | |
| 66Y9.00 | Read | Step up change in asthma management plan | diagnostic | asthma | 0 | Sensitivity | |
| 66YA.00 | Read | Step down change in asthma management plan | diagnostic | asthma | 0 | Sensitivity | |
| 66YC.00 | Read | Absent from work or school due to asthma | diagnostic | asthma | 0 | Sensitivity | |
| 66YJ.00 | Read | Asthma annual review | diagnostic | asthma | 0 | Sensitivity | |
| 66YK.00 | Read | Asthma follow-up | diagnostic | asthma | 0 | Sensitivity | |
| 66YP.00 | Read | Asthma night-time symptoms | diagnostic | asthma | 0 | Sensitivity | |
| 66YQ.00 | Read | Asthma monitoring by nurse | diagnostic | asthma | 0 | Sensitivity | |
| 66YR.00 | Read | Asthma monitoring by doctor | diagnostic | asthma | 0 | Sensitivity | |
| 8791.00 | Read | Further asthma - drug prevent. | diagnostic | asthma | 0 | Sensitivity | |
| 8793.00 | Read | Asthma control step 0 | diagnostic | asthma | 0 | Sensitivity | |
| 8794.00 | Read | Asthma control step 1 | diagnostic | asthma | 0 | Sensitivity | |
| 8795.00 | Read | Asthma control step 2 | diagnostic | asthma | 0 | Sensitivity | |
| 8796.00 | Read | Asthma control step 3 | diagnostic | asthma | 0 | Sensitivity | |
| 8797.00 | Read | Asthma control step 4 | diagnostic | asthma | 0 | Sensitivity | |
| 8798.00 | Read | Asthma control step 5 | diagnostic | asthma | 0 | Sensitivity | |
| 8B3j.00 | Read | Asthma medication review | diagnostic | asthma | 0 | Sensitivity | |
| 8CR0.00 | Read | Asthma clinical management plan | diagnostic | asthma | 0 | Sensitivity | |
| 8H2P.00 | Read | Emergency admission; asthma | diagnostic | asthma | 0 | Sensitivity | |
| 8HTT.00 | Read | Referral to asthma clinic | diagnostic | asthma | 0 | Sensitivity | |
| 9N1d.00 | Read | Seen in asthma clinic | diagnostic | asthma | 0 | Sensitivity | |
| 9NI8.00 | Read | Asthma outreach clinic | diagnostic | asthma | 0 | Sensitivity | |
| 9OJ1.00 | Read | Attends asthma monitoring | diagnostic | asthma | 0 | Sensitivity | |
| 9OJA.00 | Read | Asthma monitoring check done | diagnostic | asthma | 0 | Sensitivity | |
| 9OJA.11 | Read | Asthma monitored | diagnostic | asthma | 0 | Sensitivity | |
| c109.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c11b.00 | Read | VENTOLIN sf syrp 2mg/5ml | diagnostic | asthma | 1 | Sensitivity | |
| c11z.00 | Read | Other disorder of pancreatic internal secretion NOS | diagnostic | asthma | 1 | Sensitivity | |
| c135.00 | Read | Diabetes insipidus | diagnostic | asthma | 1 | Sensitivity | |
| c13G.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c13I.00 | Read | AIROMIR cfc free inh 100micrograms/inhalation | diagnostic | asthma | 1 | Sensitivity | |
| c13J.00 | Read | SALBUTAMOL cfc free inh 100micrograms/inhalation | diagnostic | asthma | 1 | Sensitivity | |
| c13L.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c13o.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c13T.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c13U.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c13v.00 | Read | SALBUTAMOL inh 100micrograms/inhalation | diagnostic | asthma | 1 | Sensitivity | |
| c13w.00 | Read | SALBUTAMOL unit dose neb soln 2.5mg/2.5ml | diagnostic | asthma | 1 | Sensitivity | |
| c14f.00 | Read | BRICANYL TURBOHALER 500micrograms | diagnostic | asthma | 1 | Sensitivity | |
| c14j.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c14w.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c191.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c192.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c198.00 | Read | SEREVENT ACCUHALER 50micrograms/actuation | diagnostic | asthma | 1 | Sensitivity | |
| c1C4.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c1D6.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c1Du.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c1Dv.00 | Read | SALMETEROL + FLUTICASONE cfc free inh 25micrograms + 125micrograms/actuation | diagnostic | asthma | 1 | Sensitivity | |
| c1Dw.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c1Dz.00 | Read | SALMETEROL + FLUTICASONE dry pdr inh 50micrograms+ 500micrograms/inhalation | diagnostic | asthma | 1 | Sensitivity | |
| c1E1.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c1E7.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c315.00 | Read | ATROVENT AUTOHALER breath act inh 20micrograms/actuation | diagnostic | asthma | 1 | Sensitivity | |
| c31G.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c31t.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c31u.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c31x.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c332.00 | Read | Other paraproteinaemias | diagnostic | asthma | 1 | Sensitivity | |
| c617.00 | Read | BECOTIDE 100 inh 100micrograms/actuation | diagnostic | asthma | 1 | Sensitivity | |
| c61F.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c61i.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c61O.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c61t.00 | Read | BECLOMETASONE inh 250micrograms/actuation | diagnostic | asthma | 1 | Sensitivity | |
| c61u.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c61v.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c61x.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c61z.00 | Read | BECLOMETASONE inh 100micrograms/actuation | diagnostic | asthma | 1 | Sensitivity | |
| c648.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c65f.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c65V.00 | Read | FLIXOTIDE ACCUHALER 250micrograms/inhalation | diagnostic | asthma | 1 | Sensitivity | |
| c663.00 | Read | BECOTIDE EASI-BREATHE breath act inh 100micrograms/actuation | diagnostic | asthma | 1 | Sensitivity | |
| c665.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c66a.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c66B.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| c672.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| cA11.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| cA15.00 | Read | diagnostic | asthma | 1 | Sensitivity | ||
| H312000 | Read | Chronic asthmatic bronchitis | diagnostic | asthma | 0 | Main | |
| H33..00 | Read | Asthma | diagnostic | asthma | 1 | Main | |
| H330.00 | Read | Extrinsic (atopic) asthma | diagnostic | asthma | 1 | Main | |
| H330000 | Read | Extrinsic asthma without status asthmaticus | diagnostic | asthma | 1 | Main | |
| H330011 | Read | Hay fever with asthma | diagnostic | asthma | 1 | Main | |
| H330100 | Read | Extrinsic asthma with status asthmaticus | diagnostic | asthma | 1 | Main | |
| H330.11 | Read | Allergic asthma | diagnostic | asthma | 1 | Main | |
| H330111 | Read | Extrinsic asthma with asthma attack | diagnostic | asthma | 1 | Main | |
| H330.12 | Read | Childhood asthma | diagnostic | asthma | 1 | Main | |
| H330.13 | Read | Hay fever with asthma | diagnostic | asthma | 1 | Main | |
| H330.14 | Read | Pollen asthma | diagnostic | asthma | 1 | Main | |
| H330z00 | Read | Extrinsic asthma NOS | diagnostic | asthma | 1 | Main | |
| H331.00 | Read | Intrinsic asthma | diagnostic | asthma | 1 | Main | |
| H331000 | Read | Intrinsic asthma without status asthmaticus | diagnostic | asthma | 1 | Main | |
| H33..11 | Read | Bronchial asthma | diagnostic | asthma | 1 | Main | |
| H331100 | Read | Intrinsic asthma with status asthmaticus | diagnostic | asthma | 1 | Main | |
| H331.11 | Read | Late onset asthma | diagnostic | asthma | 1 | Main | |
| H331111 | Read | Intrinsic asthma with asthma attack | diagnostic | asthma | 1 | Main | |
| H331z00 | Read | Intrinsic asthma NOS | diagnostic | asthma | 1 | Main | |
| H332.00 | Read | Mixed asthma | diagnostic | asthma | 1 | Main | |
| H333.00 | Read | Acute exacerbation of asthma | diagnostic | asthma | 0 | Sensitivity | |
| H334.00 | Read | Brittle asthma | diagnostic | asthma | 1 | Main | |
| H33z.00 | Read | Asthma unspecified | diagnostic | asthma | 1 | Main | |
| H33z000 | Read | Status asthmaticus NOS | diagnostic | asthma | 1 | Sensitivity | |
| H33z011 | Read | Severe asthma attack | diagnostic | asthma | 1 | Sensitivity | |
| h33z100 | Read | Asthma attack | diagnostic | asthma | 0 | Sensitivity | |
| H33z100 | Read | Asthma attack | diagnostic | asthma | 0 | Sensitivity | |
| H33z.11 | Read | Hyperreactive airways disease | diagnostic | asthma | 0 | Main | |
| H33z111 | Read | Asthma attack NOS | diagnostic | asthma | 0 | Sensitivity | |
| H33z200 | Read | Late-onset asthma | diagnostic | asthma | 1 | Main | |
| H33zz00 | Read | Asthma NOS | diagnostic | asthma | 1 | Main | |
| H33zz11 | Read | Exercise induced asthma | diagnostic | asthma | 1 | Main | |
| H33zz12 | Read | Allergic asthma NEC | diagnostic | asthma | 1 | Main | |
| H35y600 | Read | Sequoiosis (red-cedar asthma) | diagnostic | asthma | 0 | Main | |
| H35y700 | Read | Wood asthma | diagnostic | asthma | 0 | Main | |
| H47y000 | Read | Detergent asthma | diagnostic | asthma | 0 | Main | |
| 3052AT | OXMIS | PSYCHOGENIC ASTHMA | diagnostic | asthma | 0 | Main | |
| 493 | OXMIS | ASTHMA | diagnostic | asthma | 0 | Main | |
| 493 AA | OXMIS | ASTHMA ACUTE | diagnostic | asthma | 0 | Main | |
| 493 AB | OXMIS | ASTHMA ATTACK | diagnostic | asthma | 0 | Main | |
| 493 AD | OXMIS | ASTHMA OCCASIONAL | diagnostic | asthma | 0 | Main | |
| 493 AE | OXMIS | ASTHMA SEASONAL | diagnostic | asthma | 0 | Main | |
| 493 AH | OXMIS | ASTHMA HOSPITALISED | diagnostic | asthma | 0 | Sensitivity | |
| 493 AI | OXMIS | ASTHMA SEVERITY MILD | diagnostic | asthma | 0 | Main | |
| 493 AJ | OXMIS | ASTHMA SEVERITY MODERATE | diagnostic | asthma | 0 | Main | |
| 493 AK | OXMIS | ASTHMA SEVERITY SEVERE | diagnostic | asthma | 0 | Main | |
| 493 AR | OXMIS | ASTHMA RESOLVED | diagnostic | asthma | 0 | Resolve | |
| 493 BD | OXMIS | ASTHMA AND BRONCHITIS | diagnostic | asthma | 0 | Main | |
| 493 BF | OXMIS | ASTHMA FREQUENCY RARELY | diagnostic | asthma | 0 | Sensitivity | |
| 493 BG | OXMIS | ASTHMA FREQUENCY REGULARLY | diagnostic | asthma | 0 | Sensitivity | |
| 493 BH | OXMIS | ASTHMA FREQUENCY CONSTANTLY | diagnostic | asthma | 0 | Sensitivity | |
| 493 BI | OXMIS | ASTHMA FREQUENCY ON EXERCISE ONLY | diagnostic | asthma | 0 | Sensitivity | |
| 493 BR | OXMIS | BRONCHIAL ASTHMA | diagnostic | asthma | 0 | Main | |
| 493 C | OXMIS | CROUP ASTHMATIC | diagnostic | asthma | 0 | Main | |
| 493 CH | OXMIS | CHILDHOOD ASTHMA | diagnostic | asthma | 0 | Main | |
| 493 CJ | OXMIS | ASTHMA MEDICATION INTERMITTENTLY | diagnostic | asthma | 0 | Sensitivity | |
| 493 CK | OXMIS | ASTHMA MEDICATION PRN | diagnostic | asthma | 0 | Sensitivity | |
| 493 CL | OXMIS | ASTHMA MEDICATION REGULARLY | diagnostic | asthma | 0 | Sensitivity | |
| 493 CM | OXMIS | ASTHMA MEDICATION PROPHYLACTICLY | diagnostic | asthma | 0 | Sensitivity | |
| 493 D | OXMIS | STATUS ASTHMATICUS | diagnostic | asthma | 0 | Sensitivity | |
| 493 EA | OXMIS | ASTHMA EXERCISE INCLUDED | diagnostic | asthma | 0 | Main | |
| 493 EB | OXMIS | ASTHMA EXERCISE INDUCED | diagnostic | asthma | 0 | Main | |
| 493 EP | OXMIS | ASTHMA EPISODIC | diagnostic | asthma | 0 | Main | |
| 493 F | OXMIS | ASTHMATIC ALLERGY | diagnostic | asthma | 0 | Sensitivity | |
| 493 GR | OXMIS | ASTHMA ALLERGIC GRASS | diagnostic | asthma | 0 | Main | |
| 493 GS | OXMIS | ASTHMA POLLEN INITIATED | diagnostic | asthma | 0 | Main | |
| 493 HT | OXMIS | INTRINSIC ASTHMA | diagnostic | asthma | 0 | Main | |
| 493 JC | OXMIS | CHRONIC ASTHMA | diagnostic | asthma | 0 | Main | |
| 493 KA | OXMIS | EXACERBATION OF ASTHMA | diagnostic | asthma | 0 | Sensitivity | |
| 493 KB | OXMIS | ASTHMA EXACERBATION | diagnostic | asthma | 0 | Sensitivity | |
| 493 NA | OXMIS | NOCTURNAL ASTHMA | diagnostic | asthma | 0 | Main | |
| 691 TM | OXMIS | ECZEMA WITH ASTHMA | diagnostic | asthma | 0 | Main | |
| L4930LO | OXMIS | LATE ONSET ASTHMA | diagnostic | asthma | 0 | Main | |
| Y0601JB | OXMIS | ASTHMA CLINIC ATTENDANCE | diagnostic | asthma | 0 | Sensitivity | |
| Y060 JB | OXMIS | CLINIC ASTHMA | diagnostic | asthma | 0 | Sensitivity | |
| Y060 LE | OXMIS | ASTHMA GROUP | diagnostic | asthma | 0 | Sensitivity | |
| Y100 AR | OXMIS | ASTHMA ROUTINE ASSESSMENT | diagnostic | asthma | 0 | Sensitivity |
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