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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: body_mass_index

82 codes in list

Code Coding system Description Entity type List name QOF analysis
1621.00 Read Weight steady observation body_mass_index 0 Sensitivity
1621.11 Read Weight static observation body_mass_index 0 Sensitivity
1622.00 Read Weight increasing observation body_mass_index 0 Sensitivity
1623.00 Read Weight decreasing observation body_mass_index 0 Sensitivity
1624.00 Read Abnormal weight gain observation body_mass_index 0 Sensitivity
1625.00 Read Abnormal weight loss observation body_mass_index 0 Sensitivity
22A..00 Read O/E - weight observation body_mass_index 0 Main
22A1.00 Read O/E - weight > 20% below ideal observation body_mass_index 0 Main
22A2.00 Read O/E -weight 10-20% below ideal observation body_mass_index 0 Main
22A3.00 Read O/E - weight within 10% ideal observation body_mass_index 0 Main
22A4.00 Read O/E - weight 10-20% over ideal observation body_mass_index 0 Main
22A4.11 Read O/E - overweight observation body_mass_index 0 Main
22A5.00 Read O/E - weight > 20% over ideal observation body_mass_index 0 Main
22A5.11 Read O/E - obese observation body_mass_index 0 Main
22A6.00 Read O/E - Underweight observation body_mass_index 0 Main
22A8.00 Read Weight loss from baseline weight observation body_mass_index 0 Sensitivity
22AZ.00 Read O/E - weight NOS observation body_mass_index 0 Sensitivity
22K..00 Read Body Mass Index observation body_mass_index 1 Main
22K1.00 Read Body Mass Index normal K/M2 observation body_mass_index 1 Main
22K2.00 Read Body Mass Index high K/M2 observation body_mass_index 1 Main
22K3.00 Read Body Mass Index low K/M2 observation body_mass_index 1 Main
22K4.00 Read Body mass index index 25-29 - overweight observation body_mass_index 0 Main
22K5.00 Read Body mass index 30+ - obesity observation body_mass_index 1 Main
22K6.00 Read Body mass index less than 20 observation body_mass_index 1 Main
22K7.00 Read Body mass index 40+ - severely obese observation body_mass_index 1 Main
22K8.00 Read Body mass index 20-24 - normal observation body_mass_index 1 Main
22Z..00 Read Height and Weight observation body_mass_index 0 Main
636..00 Read Birthweight of baby observation body_mass_index 0 Main
636..11 Read Birthweight observation body_mass_index 0 Main
636..12 Read Weight - baby observation body_mass_index 0 Main
636Z.00 Read Birthweight of baby NOS observation body_mass_index 0 Main
647..00 Read Child weight centiles observation body_mass_index 0 Main
6471.00 Read Child weight < 3rd centile observation body_mass_index 0 Main
6472.00 Read Child weight=3rd-9th centile observation body_mass_index 0 Main
6473.00 Read Child weight=10th-24th centile observation body_mass_index 0 Main
6474.00 Read Child weight=25th-49th centile observation body_mass_index 0 Main
6475.00 Read Child weight=50th-74th centile observation body_mass_index 0 Main
6476.00 Read Child weight=75th-89th centile observation body_mass_index 0 Main
6477.00 Read Child weight=90th-96th centile observation body_mass_index 0 Main
6478.00 Read Child weight > 97th centile observation body_mass_index 0 Main
6479.00 Read Child weight < 0.4th centile observation body_mass_index 0 Main
647A.00 Read Child weight = 0.4th centile observation body_mass_index 0 Main
647B.00 Read Child weight 0.5th - 1.9th centile observation body_mass_index 0 Main
647C.00 Read Child weight = 2nd centile observation body_mass_index 0 Main
647D.00 Read Child weight 3rd - 8th centile observation body_mass_index 0 Main
647E.00 Read Child weight 9th centile observation body_mass_index 0 Main
647F.00 Read Child weight 10th - 24th centile observation body_mass_index 0 Main
647G.00 Read Child weight = 25th centile observation body_mass_index 0 Main
647H.00 Read Child weight 26th - 49th centile observation body_mass_index 0 Main
647I.00 Read Child weight = 50th centile observation body_mass_index 0 Main
647J.00 Read Child weight 51st - 74th centile observation body_mass_index 0 Main
647K.00 Read Child weight = 75th centile observation body_mass_index 0 Main
647L.00 Read Child weight 76th - 90th centile observation body_mass_index 0 Main
647M.00 Read Child weight = 91st centile observation body_mass_index 0 Main
647N.00 Read Child weight 92nd - 97th centile observation body_mass_index 0 Main
647O.00 Read Child weight = 98th centile observation body_mass_index 0 Main
647P.00 Read Child weight 98.1st - 99.6th centile observation body_mass_index 0 Main
647Q.00 Read Child weight > 99.6th centile observation body_mass_index 0 Main
647Z.00 Read Child weight centiles NOS observation body_mass_index 0 Main
66C..11 Read Weight monitoring observation body_mass_index 0 Sensitivity
Q111.00 Read Premature - weight 1000g-2499g or gestation of 28-37weeks observation body_mass_index 0 Main
Q114.00 Read Low birthweight observation body_mass_index 0 Main
Q114000 Read Birth weight 1000-2499 g observation body_mass_index 0 Main
Q115.00 Read Extremely low birth weight infant observation body_mass_index 0 Main
Q115000 Read Birth weight 999 g or less observation body_mass_index 0 Main
Q120.00 Read Very large baby - weight greater than 4500gm observation body_mass_index 0 Main
L3333NA OXMIS WEIGHT ABNORMAL RANGE RECORDED observation body_mass_index 0 Main
L3333NN OXMIS WEIGHT NORMAL RANGE RECORDED observation body_mass_index 0 Main
T3324PW OXMIS PERCENTILE WEIGHT observation body_mass_index 0 Main
T3324WC OXMIS WEIGHT CHECK observation body_mass_index 0 Main
T3326BA OXMIS PERCENTILE WEIGHT OUTSIDE 5% RANGE observation body_mass_index 0 Main
T3326BB OXMIS PERCENTILE WEIGHT WITHIN 5% RANGE observation body_mass_index 0 Main
T3326BC OXMIS PERCENTILE WEIGHT WITHIN 10% RANGE observation body_mass_index 0 Main
T3326BD OXMIS PERCENTILE WEIGHT WITHIN 25% RANGE observation body_mass_index 0 Main
T3326BE OXMIS PERCENTILE WEIGHT WITHIN 75% RANGE observation body_mass_index 0 Main
T3326BF OXMIS PERCENTILE WEIGHT WITHIN 90% RANGE observation body_mass_index 0 Main
T3326BG OXMIS PERCENTILE WEIGHT WITHIN 95% RANGE observation body_mass_index 0 Main
Y0601K5 OXMIS WEIGHT CONTROL CLINIC ATTENDANCE observation body_mass_index 0 Sensitivity
Y060 AY OXMIS SCREENING WEIGHT observation body_mass_index 0 Main
Y060 BY OXMIS SCREENING WEIGHT NORMAL observation body_mass_index 0 Main
Y060 CY OXMIS SCREENING WEIGHT ABNORMAL observation body_mass_index 0 Main
Y060 JY OXMIS WEIGHT CONTROL CLINIC observation body_mass_index 0 Sensitivity

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