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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: blood_pressure_measurement

57 codes in list

Code Coding system Description Entity type List name QOF analysis
246..00 Read O/E - blood pressure reading observation blood_pressure_measurement 1 Main
2461.00 Read O/E - BP reading very low observation blood_pressure_measurement 1 Main
246..11 Read O/E - BP reading observation blood_pressure_measurement 1 Main
246..12 Read O/E - blood pressure observation blood_pressure_measurement 1 Main
2462.00 Read O/E - BP reading low observation blood_pressure_measurement 1 Main
2463.00 Read O/E - BP borderline low observation blood_pressure_measurement 1 Main
2464.00 Read O/E - BP reading normal observation blood_pressure_measurement 1 Main
2465.00 Read O/E - BP borderline raised observation blood_pressure_measurement 1 Main
2466.00 Read O/E - BP reading raised observation blood_pressure_measurement 1 Main
2467.00 Read O/E - BP reading very high observation blood_pressure_measurement 1 Main
2468.00 Read O/E - BP reading:postural drop observation blood_pressure_measurement 1 Main
2469.00 Read O/E - Systolic BP reading observation blood_pressure_measurement 1 Main
246a.00 Read Average night interval diastolic blood pressure observation blood_pressure_measurement 1 Sensitivity
246A.00 Read O/E - Diastolic BP reading observation blood_pressure_measurement 1 Main
246b.00 Read Average night interval systolic blood pressure observation blood_pressure_measurement 1 Sensitivity
246B.00 Read O/E - BP stable observation blood_pressure_measurement 1 Main
246c.00 Read Average home diastolic blood pressure observation blood_pressure_measurement 1 Sensitivity
246C.00 Read Lying blood pressure reading observation blood_pressure_measurement 1 Main
246d.00 Read Average home systolic blood pressure observation blood_pressure_measurement 1 Sensitivity
246D.00 Read Standing blood pressure reading observation blood_pressure_measurement 1 Main
246e.00 Read Ambulatory systolic blood pressure observation blood_pressure_measurement 1 Main
246E.00 Read Sitting blood pressure reading observation blood_pressure_measurement 1 Main
246f.00 Read Ambulatory diastolic blood pressure observation blood_pressure_measurement 1 Main
246F.00 Read O/E - blood pressure decreased observation blood_pressure_measurement 1 Main
246G.00 Read O/E - BP labile observation blood_pressure_measurement 1 Main
246J.00 Read O/E - BP reading: no postural drop observation blood_pressure_measurement 1 Main
246N.00 Read Standing systolic blood pressure observation blood_pressure_measurement 1 Main
246P.00 Read Standing diastolic blood pressure observation blood_pressure_measurement 1 Main
246Q.00 Read Sitting systolic blood pressure observation blood_pressure_measurement 1 Main
246R.00 Read Sitting diastolic blood pressure observation blood_pressure_measurement 1 Main
246S.00 Read Lying systolic blood pressure observation blood_pressure_measurement 1 Main
246T.00 Read Lying diastolic blood pressure observation blood_pressure_measurement 1 Main
246V.00 Read Average 24 hour diastolic blood pressure observation blood_pressure_measurement 1 Main
246W.00 Read Average 24 hour systolic blood pressure observation blood_pressure_measurement 1 Main
246X.00 Read Average day interval diastolic blood pressure observation blood_pressure_measurement 1 Main
246Y.00 Read Average day interval systolic blood pressure observation blood_pressure_measurement 1 Main
246Z.00 Read O/E-blood pressure reading NOS observation blood_pressure_measurement 1 Main
6623.00 Read Pre-treatment BP reading observation blood_pressure_measurement 0 Main
662B.00 Read O/E - initial high BP observation blood_pressure_measurement 0 Main
662C.00 Read O/E - check high BP observation blood_pressure_measurement 0 Main
662L.00 Read 24 hr blood pressure monitoring observation blood_pressure_measurement 0 Main
R1y2.00 Read [D]Raised blood pressure reading observation blood_pressure_measurement 0 Main
R1y3.00 Read [D]Low blood pressure reading observation blood_pressure_measurement 0 Main
ZV70B00 Read [V]Examination of blood pressure observation blood_pressure_measurement 0 Sensitivity
4010C OXMIS BLOOD PRESSURE CHECK observation blood_pressure_measurement 0 Main
4010CA OXMIS BP CHECKED observation blood_pressure_measurement 0 Main
4010T OXMIS BP TAKEN observation blood_pressure_measurement 0 Main
4010TL OXMIS BLOOD PRESSURE TAKEN LYING DOWN observation blood_pressure_measurement 0 Main
4010TM OXMIS BP TAKEN LYING DOWN observation blood_pressure_measurement 0 Main
4010TS OXMIS BP TAKEN STANDING observation blood_pressure_measurement 0 Main
4010TT OXMIS BLOOD PRESSURE TAKEN STANDING observation blood_pressure_measurement 0 Main
4010TU OXMIS BP TAKEN SITTING observation blood_pressure_measurement 0 Main
4010TV OXMIS BLOOD PRESSURE TAKEN SITTING observation blood_pressure_measurement 0 Main
D2530 OXMIS BLOOD PRESSURE RECORDED observation blood_pressure_measurement 0 Main
Y060 AA OXMIS SCREENING BLOOD PRESSURE observation blood_pressure_measurement 0 Sensitivity
Y060 BA OXMIS SCREENING BLOOD PRESSURE NORMAL observation blood_pressure_measurement 0 Sensitivity
Y060 CA OXMIS SCREENING BLOOD PRESSURE ABNORMAL observation blood_pressure_measurement 0 Sensitivity

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