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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: chronic obstructive pulmonary diasease
66 codes in list
| Code | Coding system | Description | Entity type | List name | QOF | analysis | |
|---|---|---|---|---|---|---|---|
| 66YB.00 | Read | Chronic obstructive pulmonary disease monitoring | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66Yd.00 | Read | COPD accident and emergency attendance since last visit | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66YD.00 | Read | Chronic obstructive pulmonary disease monitoring due | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66Ye.00 | Read | Emergency COPD admission since last appointment | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66Yf.00 | Read | Number of COPD exacerbations in past year | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66Yg.00 | Read | Chronic obstructive pulmonary disease disturbs sleep | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66Yh.00 | Read | Chronic obstructive pulmonary disease does not disturb sleep | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66Yi.00 | Read | Multiple COPD emergency hospital admissions | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66YI.00 | Read | COPD self-management plan given | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66YL.00 | Read | Chronic obstructive pulmonary disease follow-up | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66YL.11 | Read | COPD follow-up | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66YL.12 | Read | COAD follow-up | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66YM.00 | Read | Chronic obstructive pulmonary disease annual review | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66YS.00 | Read | Chronic obstructive pulmonary disease monitoring by nurse | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 66YT.00 | Read | Chronic obstructive pulmonary disease monitoring by doctor | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 8H2R.00 | Read | Admit COPD emergency | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| H3...00 | Read | Chronic obstructive pulmonary disease | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H31..00 | Read | Chronic bronchitis | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H310.00 | Read | Simple chronic bronchitis | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H310000 | Read | Chronic catarrhal bronchitis | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H310z00 | Read | Simple chronic bronchitis NOS | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H311.00 | Read | Mucopurulent chronic bronchitis | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H311000 | Read | Purulent chronic bronchitis | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H311100 | Read | Fetid chronic bronchitis | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H311z00 | Read | Mucopurulent chronic bronchitis NOS | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H312.00 | Read | Obstructive chronic bronchitis | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H312000 | Read | Chronic asthmatic bronchitis | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H312011 | Read | Chronic wheezy bronchitis | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H312100 | Read | Emphysematous bronchitis | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H312200 | Read | Acute exacerbation of chronic obstructive airways disease | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| H312300 | Read | Bronchiolitis obliterans | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H312z00 | Read | Obstructive chronic bronchitis NOS | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H313.00 | Read | Mixed simple and mucopurulent chronic bronchitis | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H31y.00 | Read | Other chronic bronchitis | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H31y100 | Read | Chronic tracheobronchitis | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H31yz00 | Read | Other chronic bronchitis NOS | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H31z.00 | Read | Chronic bronchitis NOS | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H32..00 | Read | Emphysema | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H320.00 | Read | Chronic bullous emphysema | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H320000 | Read | Segmental bullous emphysema | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H320100 | Read | Zonal bullous emphysema | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H320200 | Read | Giant bullous emphysema | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H320300 | Read | Bullous emphysema with collapse | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H320z00 | Read | Chronic bullous emphysema NOS | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H321.00 | Read | Panlobular emphysema | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H322.00 | Read | Centrilobular emphysema | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H32y.00 | Read | Other emphysema | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H32y000 | Read | Acute vesicular emphysema | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H32y100 | Read | Atrophic (senile) emphysema | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H32y111 | Read | Acute interstitial emphysema | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H32y200 | Read | MacLeod's unilateral emphysema | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H32yz00 | Read | Other emphysema NOS | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H32z.00 | Read | Emphysema NOS | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H36..00 | Read | Mild chronic obstructive pulmonary disease | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H37..00 | Read | Moderate chronic obstructive pulmonary disease | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H38..00 | Read | Severe chronic obstructive pulmonary disease | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H3y..11 | Read | Other specified chronic obstructive pulmonary disease | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| H3z..11 | Read | Chronic obstructive pulmonary disease NOS | diagnostic | chronic obstructive pulmonary diasease | 1 | Main | |
| 491 | OXMIS | CHRONIC BRONCHITIS | diagnostic | chronic obstructive pulmonary diasease | 0 | Main | |
| 491 E | OXMIS | CHRONIC BRONCHITIS WITH EMPHYSEMA | diagnostic | chronic obstructive pulmonary diasease | 0 | Main | |
| 492 | OXMIS | EMPHYSEMA PULMONARY | diagnostic | chronic obstructive pulmonary diasease | 0 | Main | |
| 492 AC | OXMIS | EMPHYSEMA APICAL BULLAE | diagnostic | chronic obstructive pulmonary diasease | 0 | Main | |
| 5199G | OXMIS | OBSTRUCTIVE AIRWAYS DISEASE CHRONIC | diagnostic | chronic obstructive pulmonary diasease | 0 | Main | |
| 5199GE | OXMIS | EXACERBATION COAD | diagnostic | chronic obstructive pulmonary diasease | 0 | Sensitivity | |
| 5199GL | OXMIS | COLD (CHRONIC OBSTRUCTIVE LUNG DISEASE) | diagnostic | chronic obstructive pulmonary diasease | 0 | Main | |
| 5199GP | OXMIS | COPD (CHRONIC OBSTRUCTIVE PULMONARY DISE | diagnostic | chronic obstructive pulmonary diasease | 0 | Main |
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