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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: back pain
117 codes in list
| Code | Coding system | Description | Entity type | List name | analysis | ||
|---|---|---|---|---|---|---|---|
| 16C4.00 | Read | Back pain worse on sneezing | diagnostic | back pain | Main | ||
| 16C5.00 | Read | C/O - low back pain | diagnostic | back pain | Main | ||
| 16C6.00 | Read | Back pain without radiation NOS | diagnostic | back pain | Main | ||
| 16C9.00 | Read | Chronic low back pain | diagnostic | back pain | Main | ||
| 16CA.00 | Read | Mechanical low back pain | diagnostic | back pain | Main | ||
| 1A53.12 | Read | C/O - lumbar pain | diagnostic | back pain | Main | ||
| 25C..13 | Read | O/E - lumbar pain on palpation | diagnostic | back pain | Main | ||
| 25C5.00 | Read | O/E - abd. pain - R.lumbar | diagnostic | back pain | Main | ||
| 25C7.00 | Read | O/E - abd. pain - L.lumbar | diagnostic | back pain | Main | ||
| 8HTH.00 | Read | Referral to back pain clinic | diagnostic | back pain | Sensitivity | ||
| F350.00 | Read | Sciatic nerve lesion | diagnostic | back pain | Sensitivity | ||
| J3A..00 | Read | Sciatic hernia | diagnostic | back pain | Main | ||
| J3A0.00 | Read | Sciatic hernia with gangrene | diagnostic | back pain | Main | ||
| J3A1.00 | Read | Sciatic hernia with obstruction | diagnostic | back pain | Main | ||
| J3A2.00 | Read | Sciatic hernia - irreducible | diagnostic | back pain | Main | ||
| J3A3.00 | Read | Simple sciatic hernia | diagnostic | back pain | Main | ||
| J3Ay.00 | Read | Unspecified sciatic hernia | diagnostic | back pain | Main | ||
| J3Az.00 | Read | Sciatic hernia NOS | diagnostic | back pain | Main | ||
| N12..13 | Read | Acute back pain - disc | diagnostic | back pain | Main | ||
| N12C400 | Read | Prolapsed lumbar intervertebral disc with sciatica | diagnostic | back pain | Main | ||
| N140.00 | Read | Spinal stenosis; excluding cervical region | diagnostic | back pain | Main | ||
| N140000 | Read | Spinal stenosis of unspecified region | diagnostic | back pain | Main | ||
| N140100 | Read | Thoracic spinal stenosis | diagnostic | back pain | Main | ||
| N140.11 | Read | Spinal stenosis | diagnostic | back pain | Main | ||
| N140200 | Read | Lumbar spinal stenosis | diagnostic | back pain | Main | ||
| N140300 | Read | Idiopathic thoracic spinal stenosis | diagnostic | back pain | Main | ||
| N140400 | Read | Degenerative thoracic spinal stenosis | diagnostic | back pain | Main | ||
| N140500 | Read | Iatrogenic thoracic spinal stenosis | diagnostic | back pain | Main | ||
| N140600 | Read | Thoracic spinal stenosis secondary to other disease | diagnostic | back pain | Main | ||
| N140700 | Read | Idiopathic lumbar spinal stenosis | diagnostic | back pain | Main | ||
| N140800 | Read | Degenerative lumbar spinal stenosis | diagnostic | back pain | Main | ||
| N140900 | Read | Iatrogenic lumbar spinal stenosis | diagnostic | back pain | Main | ||
| N140A00 | Read | Lumbar spinal stenosis secondary to other disease | diagnostic | back pain | Main | ||
| N140z00 | Read | Spinal stenosis NOS | diagnostic | back pain | Main | ||
| N141.00 | Read | Pain in thoracic spine | diagnostic | back pain | Main | ||
| N141.11 | Read | Acute back pain - thoracic | diagnostic | back pain | Main | ||
| n142.00 | Read | Pain in lumbar spine | diagnostic | back pain | Main | ||
| N142.00 | Read | Pain in lumbar spine | diagnostic | back pain | Main | ||
| N142000 | Read | Lumbago with sciatica | diagnostic | back pain | Main | ||
| N142.11 | Read | Low back pain | diagnostic | back pain | Main | ||
| N142.12 | Read | Lumbalgia | diagnostic | back pain | Main | ||
| N142.13 | Read | Acute back pain - lumbar | diagnostic | back pain | Main | ||
| N142.14 | Read | Lumbago | diagnostic | back pain | Main | ||
| N143.00 | Read | Sciatica | diagnostic | back pain | Main | ||
| N143.11 | Read | Acute back pain with sciatica | diagnostic | back pain | Main | ||
| N144.00 | Read | Thoracic and lumbosacral neuritis | diagnostic | back pain | Main | ||
| N144000 | Read | Thoracic neuritis; unspecified | diagnostic | back pain | Main | ||
| N144011 | Read | Thoracic nerve root pain | diagnostic | back pain | Main | ||
| N144100 | Read | Lumbosacral neuritis; unspecified | diagnostic | back pain | Main | ||
| N144z00 | Read | Thoracic and lumbosacral neuritis NOS | diagnostic | back pain | Main | ||
| N145.00 | Read | Backache; unspecified | diagnostic | back pain | Main | ||
| N145.11 | Read | Acute back pain - unspecified | diagnostic | back pain | Main | ||
| N145.12 | Read | Back pain; unspecified | diagnostic | back pain | Main | ||
| N146000 | Read | Lumbosacral ankylosis | diagnostic | back pain | Main | ||
| N146100 | Read | Sacroiliac ankylosis | diagnostic | back pain | Main | ||
| N146200 | Read | Sacral ankylosis NOS | diagnostic | back pain | Main | ||
| N146300 | Read | Lumbosacral instability | diagnostic | back pain | Main | ||
| N146311 | Read | Lumbosacral strain | diagnostic | back pain | Main | ||
| N146400 | Read | Sacroiliac instability | diagnostic | back pain | Main | ||
| N146500 | Read | Sacral instability NOS | diagnostic | back pain | Sensitivity | ||
| N146600 | Read | Sacroiliac disorder | diagnostic | back pain | Sensitivity | ||
| N146z11 | Read | Sacroiliac strain | diagnostic | back pain | Main | ||
| N147100 | Read | Hypermobility of the coccyx | diagnostic | back pain | Sensitivity | ||
| N147200 | Read | Coccygodynia | diagnostic | back pain | Main | ||
| N147211 | Read | Pain in coccyx | diagnostic | back pain | Main | ||
| N148.00 | Read | Ankylosis/instability of cervical;thoracic or lumbar spine | diagnostic | back pain | Main | ||
| N148000 | Read | Atlanto-occipital ankylosis | diagnostic | back pain | Main | ||
| N148100 | Read | Atlanto-axial ankylosis | diagnostic | back pain | Main | ||
| N148200 | Read | Cervical spine ankylosis | diagnostic | back pain | Main | ||
| N148300 | Read | Cervico-thoracic ankylosis | diagnostic | back pain | Main | ||
| N148400 | Read | Thoracic spine ankylosis | diagnostic | back pain | Main | ||
| N148500 | Read | Thoraco-lumbar ankylosis | diagnostic | back pain | Main | ||
| N148600 | Read | Lumbar spine ankylosis | diagnostic | back pain | Main | ||
| N148700 | Read | Atlanto-occipital instability | diagnostic | back pain | Main | ||
| N148800 | Read | Atlanto-axial instability | diagnostic | back pain | Main | ||
| N148900 | Read | Cervical spine instability | diagnostic | back pain | Main | ||
| N148A00 | Read | Cervico-thoracic instability | diagnostic | back pain | Main | ||
| N148B00 | Read | Thoracic spine instability | diagnostic | back pain | Main | ||
| N148C00 | Read | Lumbar spine instability | diagnostic | back pain | Main | ||
| N149.00 | Read | Back stiffness | diagnostic | back pain | Main | ||
| N14y.11 | Read | Facet joint syndrome | diagnostic | back pain | Main | ||
| N14z.11 | Read | Ankylosis of spine NOS | diagnostic | back pain | Main | ||
| N23yE00 | Read | Spasm of back muscles | diagnostic | back pain | Main | ||
| SJ60.00 | Read | Sciatic nerve injury | diagnostic | back pain | Main | ||
| SJ60000 | Read | Closed injury sciatic nerve | diagnostic | back pain | Main | ||
| SJ60100 | Read | Open injury sciatic nerve | diagnostic | back pain | Main | ||
| 353 | OXMIS | SCIATICA | diagnostic | back pain | Main | ||
| 353 A | OXMIS | SCIATICA ACUTE | diagnostic | back pain | Main | ||
| 353 C | OXMIS | SCIATICA CHRONIC | diagnostic | back pain | Main | ||
| 353 HP | OXMIS | PALSY SCIATIC HIGH | diagnostic | back pain | Sensitivity | ||
| 353 NP | OXMIS | SCIATIC NEUROPATHY | diagnostic | back pain | Main | ||
| 353 NT | OXMIS | SCIATICA NEURITIS | diagnostic | back pain | Main | ||
| 353 PP | OXMIS | SCIATIC PARAESTHESIA | diagnostic | back pain | Sensitivity | ||
| 353 T | OXMIS | SCIATICA TRAUMATIC | diagnostic | back pain | Main | ||
| 5518AT | OXMIS | SCIATIC HERNIA | diagnostic | back pain | Main | ||
| 7251D | OXMIS | SCIATICA POSSIBLE INTERVERTEBRAL DISC LE | diagnostic | back pain | Main | ||
| 7287A | OXMIS | PAIN LOW BACK | diagnostic | back pain | Main | ||
| 7287B | OXMIS | PAIN LUMBAR REGION | diagnostic | back pain | Main | ||
| 7288RP | OXMIS | PAIN LUMBAR ROOT NEUROPATHY | diagnostic | back pain | Main | ||
| 7289A | OXMIS | SCIATICA WITH BACK PAIN | diagnostic | back pain | Main | ||
| 7289B | OXMIS | PAIN BACK WITH NEURITIS | diagnostic | back pain | Main | ||
| 7289C | OXMIS | BAD BACK | diagnostic | back pain | Main | ||
| 7289CA | OXMIS | VERTEBROGENIC PAIN SYNDROME | diagnostic | back pain | Main | ||
| 7289CB | OXMIS | CHRONIC BACKACHE | diagnostic | back pain | Main | ||
| 7289CC | OXMIS | PAIN COCCYX | diagnostic | back pain | Main | ||
| 7289CE | OXMIS | SYNDROME CAUDA EQUINA | diagnostic | back pain | Main | ||
| 7289CF | OXMIS | BACKACHE | diagnostic | back pain | Main | ||
| 7289CG | OXMIS | ACHE SPINE | diagnostic | back pain | Main | ||
| 7289CH | OXMIS | PAIN BACK | diagnostic | back pain | Main | ||
| 7289CI | OXMIS | TROUBLE BACK | diagnostic | back pain | Sensitivity | ||
| 7289CT | OXMIS | ACUTE BACK (PAIN) | diagnostic | back pain | Main | ||
| 7289D | OXMIS | PAIN BACK WITHOUT SCIATICA | diagnostic | back pain | Main | ||
| 7289E | OXMIS | COCCYDINIA | diagnostic | back pain | Main | ||
| 7289G | OXMIS | ACHE UPPER SPINE | diagnostic | back pain | Main | ||
| 7289H | OXMIS | ACHE LUMBOSACRAL | diagnostic | back pain | Main | ||
| 7289J | OXMIS | PAIN LOIN | diagnostic | back pain | Main | ||
| 7289PL | OXMIS | POSTURAL BACKACHE | diagnostic | back pain | Main |
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