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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


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
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

Code list: cold

309 codes in list

Code Coding system Description Entity type List name analysis
1656.00 Read Feverish cold diagnostic cold Main
171..00 Read Cough diagnostic cold Main
171..11 Read C/O - cough diagnostic cold Main
1712.00 Read Dry cough diagnostic cold Main
1713.00 Read Productive cough -clear sputum diagnostic cold Main
1714.00 Read Productive cough -green sputum diagnostic cold Main
1715.00 Read Productive cough-yellow sputum diagnostic cold Main
1716.00 Read Productive cough NOS diagnostic cold Main
1716.11 Read Coughing up phlegm diagnostic cold Main
1717.00 Read Night cough present diagnostic cold Sensitivity
1719.00 Read Chesty cough diagnostic cold Main
1719.11 Read Bronchial cough diagnostic cold Main
171A.00 Read Chronic cough diagnostic cold Main
171B.00 Read Persistent cough diagnostic cold Main
171C.00 Read Morning cough diagnostic cold Sensitivity
171D.00 Read Evening cough diagnostic cold Sensitivity
171E.00 Read Unexplained cough diagnostic cold Sensitivity
171F.00 Read Cough with fever diagnostic cold Main
171G.00 Read Bovine cough diagnostic cold Sensitivity
171H.00 Read Difficulty in coughing up sputum diagnostic cold Main
171J.00 Read Reflux cough diagnostic cold Main
171Z.00 Read Cough symptom NOS diagnostic cold Sensitivity
173B.00 Read Nocturnal cough / wheeze diagnostic cold Sensitivity
1C9..00 Read Sore throat symptom diagnostic cold Sensitivity
1C92.00 Read Has a sore throat diagnostic cold Main
1C93.00 Read Persistent sore throat diagnostic cold Main
1C9Z.00 Read Sore throat symptom NOS diagnostic cold Sensitivity
2DB6.00 Read O/E - follicular tonsillitis diagnostic cold Main
A34..00 Read Streptococcal sore throat and scarlatina diagnostic cold Main
A340.00 Read Streptococcal sore throat diagnostic cold Main
A340000 Read Streptococcal angina diagnostic cold Main
A340100 Read Streptococcal laryngitis diagnostic cold Main
A340200 Read Streptococcal pharyngitis diagnostic cold Main
A340300 Read Streptococcal tonsillitis diagnostic cold Main
A340z00 Read Streptococcal sore throat NOS diagnostic cold Main
A341.00 Read Scarlet fever - scarlatina diagnostic cold Main
A341.11 Read Scarlet fever diagnostic cold Main
A341.12 Read Scarlatina diagnostic cold Main
A34z.00 Read Streptococcal sore throat with scarlatina NOS diagnostic cold Main
A383000 Read Fusobacterial necrotising tonsillitis diagnostic cold Main
A552.00 Read Postmeasles otitis media diagnostic cold Main
A793.00 Read Rhinovirus diagnostic cold Main
AA1z.12 Read Vincent's tonsillitis diagnostic cold Main
F51..00 Read Nonsuppurative otitis media + eustachian tube disorders diagnostic cold Main
F510.00 Read Acute non suppurative otitis media diagnostic cold Main
F510000 Read Acute otitis media with effusion diagnostic cold Main
F510011 Read Acute secretory otitis media diagnostic cold Main
F510100 Read Acute serous otitis media