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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: coronary heart disease
147 codes in list
| Code | Coding system | Description | Entity type | List name | QOF | analysis | |
|---|---|---|---|---|---|---|---|
| 14AJ.00 | Read | H/O: Angina in last year | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 662K.00 | Read | Angina control | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 662K000 | Read | Angina control - good | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 662K100 | Read | Angina control - poor | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 662K200 | Read | Angina control - improving | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 662K300 | Read | Angina control - worsening | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 662Kz00 | Read | Angina control NOS | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 662N.00 | Read | CHD monitoring | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 6A2..00 | Read | Coronary heart disease annual review | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 6A4..00 | Read | Coronary heart disease review | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 8B27.00 | Read | Antianginal therapy | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 8B3k.00 | Read | Coronary heart disease medication review | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 8B63.11 | Read | Aspirin prophylaxis - IHD | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 8CR6.00 | Read | Coronary heart disease risk clinical management plan | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 9Ob0.00 | Read | Attends coronary heart disease monitoring | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 9Ob8.00 | Read | Coronary heart disease monitoring check done | diagnostic | coronary heart disease | 0 | Sensitivity | |
| G3...00 | Read | Ischaemic heart disease | diagnostic | coronary heart disease | 1 | Main | |
| G30..00 | Read | Acute myocardial infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G300.00 | Read | Acute anterolateral infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G301.00 | Read | Other specified anterior myocardial infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G301000 | Read | Acute anteroapical infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30..11 | Read | Attack - heart | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G301100 | Read | Acute anteroseptal infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30..12 | Read | Coronary thrombosis | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30..13 | Read | Cardiac rupture following myocardial infarction (MI) | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30..14 | Read | Heart attack | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30..15 | Read | MI - acute myocardial infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30..16 | Read | Thrombosis - coronary | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30..17 | Read | Silent myocardial infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G301z00 | Read | Anterior myocardial infarction NOS | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G302.00 | Read | Acute inferolateral infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G303.00 | Read | Acute inferoposterior infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G304.00 | Read | Posterior myocardial infarction NOS | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G305.00 | Read | Lateral myocardial infarction NOS | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G306.00 | Read | True posterior myocardial infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G307.00 | Read | Acute subendocardial infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G307000 | Read | Acute non-Q wave infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G307100 | Read | Acute non-ST segment elevation myocardial infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G308.00 | Read | Inferior myocardial infarction NOS | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G309.00 | Read | Acute Q-wave infarct | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30A.00 | Read | Mural thrombosis | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30B.00 | Read | Acute posterolateral myocardial infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30X.00 | Read | Acute transmural myocardial infarction of unspecif site | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30X000 | Read | Acute ST segment elevation myocardial infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30y.00 | Read | Other acute myocardial infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30y000 | Read | Acute atrial infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30y100 | Read | Acute papillary muscle infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30y200 | Read | Acute septal infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30yz00 | Read | Other acute myocardial infarction NOS | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G30z.00 | Read | Acute myocardial infarction NOS | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G31..00 | Read | Other acute and subacute ischaemic heart disease | diagnostic | coronary heart disease | 1 | Main | |
| G310.00 | Read | Postmyocardial infarction syndrome | diagnostic | coronary heart disease | 1 | Main | |
| G310.11 | Read | Dressler's syndrome | diagnostic | coronary heart disease | 1 | Main | |
| G3...11 | Read | Arteriosclerotic heart disease | diagnostic | coronary heart disease | 1 | Main | |
| G311.00 | Read | Preinfarction syndrome | diagnostic | coronary heart disease | 1 | Main | |
| G311000 | Read | Myocardial infarction aborted | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G311011 | Read | MI - myocardial infarction aborted | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G311100 | Read | Unstable angina | diagnostic | coronary heart disease | 1 | Main | |
| G311.11 | Read | Crescendo angina | diagnostic | coronary heart disease | 1 | Main | |
| G311.12 | Read | Impending infarction | diagnostic | coronary heart disease | 1 | Main | |
| G311.13 | Read | Unstable angina | diagnostic | coronary heart disease | 1 | Main | |
| G311.14 | Read | Angina at rest | diagnostic | coronary heart disease | 1 | Main | |
| G311200 | Read | Angina at rest | diagnostic | coronary heart disease | 1 | Main | |
| G311300 | Read | Refractory angina | diagnostic | coronary heart disease | 1 | Main | |
| G311400 | Read | Worsening angina | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G311500 | Read | Acute coronary syndrome | diagnostic | coronary heart disease | 1 | Main | |
| G311z00 | Read | Preinfarction syndrome NOS | diagnostic | coronary heart disease | 1 | Main | |
| G3...12 | Read | Atherosclerotic heart disease | diagnostic | coronary heart disease | 1 | Main | |
| G312.00 | Read | Coronary thrombosis not resulting in myocardial infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G3...13 | Read | IHD - Ischaemic heart disease | diagnostic | coronary heart disease | 1 | Main | |
| G31y.00 | Read | Other acute and subacute ischaemic heart disease | diagnostic | coronary heart disease | 1 | Main | |
| G31y000 | Read | Acute coronary insufficiency | diagnostic | coronary heart disease | 1 | Main | |
| G31y100 | Read | Microinfarction of heart | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G31y200 | Read | Subendocardial ischaemia | diagnostic | coronary heart disease | 1 | Main | |
| G31y300 | Read | Transient myocardial ischaemia | diagnostic | coronary heart disease | 1 | Main | |
| G31yz00 | Read | Other acute and subacute ischaemic heart disease NOS | diagnostic | coronary heart disease | 1 | Main | |
| G32..00 | Read | Old myocardial infarction | diagnostic | coronary heart disease | 1 | Main | |
| G32..11 | Read | Healed myocardial infarction | diagnostic | coronary heart disease | 1 | Main | |
| G32..12 | Read | Personal history of myocardial infarction | diagnostic | coronary heart disease | 1 | Main | |
| G33..00 | Read | Angina pectoris | diagnostic | coronary heart disease | 1 | Main | |
| G330.00 | Read | Angina decubitus | diagnostic | coronary heart disease | 1 | Main | |
| G330000 | Read | Nocturnal angina | diagnostic | coronary heart disease | 1 | Main | |
| G330z00 | Read | Angina decubitus NOS | diagnostic | coronary heart disease | 1 | Main | |
| G331.00 | Read | Prinzmetal's angina | diagnostic | coronary heart disease | 1 | Main | |
| G331.11 | Read | Variant angina pectoris | diagnostic | coronary heart disease | 1 | Main | |
| G332.00 | Read | Coronary artery spasm | diagnostic | coronary heart disease | 1 | Main | |
| G33z.00 | Read | Angina pectoris NOS | diagnostic | coronary heart disease | 1 | Main | |
| G33z000 | Read | Status anginosus | diagnostic | coronary heart disease | 1 | Main | |
| G33z100 | Read | Stenocardia | diagnostic | coronary heart disease | 1 | Main | |
| G33z200 | Read | Syncope anginosa | diagnostic | coronary heart disease | 1 | Main | |
| G33z300 | Read | Angina on effort | diagnostic | coronary heart disease | 1 | Main | |
| G33z400 | Read | Ischaemic chest pain | diagnostic | coronary heart disease | 1 | Main | |
| G33z500 | Read | Post infarct angina | diagnostic | coronary heart disease | 1 | Main | |
| G33z600 | Read | New onset angina | diagnostic | coronary heart disease | 1 | Main | |
| G33z700 | Read | Stable angina | diagnostic | coronary heart disease | 1 | Main | |
| G33zz00 | Read | Angina pectoris NOS | diagnostic | coronary heart disease | 1 | Main | |
| G34..00 | Read | Other chronic ischaemic heart disease | diagnostic | coronary heart disease | 1 | Main | |
| G340.00 | Read | Coronary atherosclerosis | diagnostic | coronary heart disease | 1 | Main | |
| G340000 | Read | Single coronary vessel disease | diagnostic | coronary heart disease | 1 | Main | |
| G340100 | Read | Double coronary vessel disease | diagnostic | coronary heart disease | 1 | Main | |
| G340.11 | Read | Triple vessel disease of the heart | diagnostic | coronary heart disease | 1 | Main | |
| G340.12 | Read | Coronary artery disease | diagnostic | coronary heart disease | 1 | Main | |
| G342.00 | Read | Atherosclerotic cardiovascular disease | diagnostic | coronary heart disease | 1 | Main | |
| G343.00 | Read | Ischaemic cardiomyopathy | diagnostic | coronary heart disease | 1 | Main | |
| G344.00 | Read | Silent myocardial ischaemia | diagnostic | coronary heart disease | 1 | Main | |
| G34y.00 | Read | Other specified chronic ischaemic heart disease | diagnostic | coronary heart disease | 1 | Main | |
| G34y000 | Read | Chronic coronary insufficiency | diagnostic | coronary heart disease | 1 | Main | |
| G34y100 | Read | Chronic myocardial ischaemia | diagnostic | coronary heart disease | 1 | Main | |
| G34yz00 | Read | Other specified chronic ischaemic heart disease NOS | diagnostic | coronary heart disease | 1 | Main | |
| G34z.00 | Read | Other chronic ischaemic heart disease NOS | diagnostic | coronary heart disease | 1 | Main | |
| G34z000 | Read | Asymptomatic coronary heart disease | diagnostic | coronary heart disease | 1 | Main | |
| G35..00 | Read | Subsequent myocardial infarction | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G350.00 | Read | Subsequent myocardial infarction of anterior wall | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G351.00 | Read | Subsequent myocardial infarction of inferior wall | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G353.00 | Read | Subsequent myocardial infarction of other sites | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G35X.00 | Read | Subsequent myocardial infarction of unspecified site | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G36..00 | Read | Certain current complication follow acute myocardial infarct | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G360.00 | Read | Haemopericardium/current comp folow acut myocard infarct | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G361.00 | Read | Atrial septal defect/curr comp folow acut myocardal infarct | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G362.00 | Read | Ventric septal defect/curr comp fol acut myocardal infarctn | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G363.00 | Read | Ruptur cardiac wall w'out haemopericard/cur comp fol ac MI | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G364.00 | Read | Ruptur chordae tendinae/curr comp fol acute myocard infarct | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G365.00 | Read | Rupture papillary muscle/curr comp fol acute myocard infarct | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G366.00 | Read | Thrombosis atrium;auric append&vent/curr comp foll acute MI | diagnostic | coronary heart disease | 1 | Sensitivity | |
| G3y..00 | Read | Other specified ischaemic heart disease | diagnostic | coronary heart disease | 1 | Main | |
| G3z..00 | Read | Ischaemic heart disease NOS | diagnostic | coronary heart disease | 1 | Main | |
| Gyu3.00 | Read | [X]Ischaemic heart diseases | diagnostic | coronary heart disease | 1 | Main | |
| Gyu3200 | Read | [X]Other forms of acute ischaemic heart disease | diagnostic | coronary heart disease | 1 | Main | |
| Gyu3300 | Read | [X]Other forms of chronic ischaemic heart disease | diagnostic | coronary heart disease | 1 | Main | |
| 4119B | OXMIS | ISCHAEMIC HEART DISEASE SUBACUTE | diagnostic | coronary heart disease | 0 | Main | |
| 4120A | OXMIS | ISCHAEMIC HEART DISEASE HYPERTENSIVE | diagnostic | coronary heart disease | 0 | Main | |
| 4129 | OXMIS | ISCHAEMIC HEART DISEASE CHRONIC | diagnostic | coronary heart disease | 0 | Main | |
| 4129AN | OXMIS | ISCHAEMIC HEART DISEASE | diagnostic | coronary heart disease | 0 | Main | |
| 4129N | OXMIS | ISCHAEMIC HEART DISEASE ASYMPTOMATIC | diagnostic | coronary heart disease | 0 | Main | |
| 4130 | OXMIS | ANGINA PECTORIS WITH HYPERTENSION | diagnostic | coronary heart disease | 0 | Main | |
| 4130E | OXMIS | ANGINA EFFORT WITH HYPERTENSION | diagnostic | coronary heart disease | 0 | Main | |
| 4139 | OXMIS | ANGINA PECTORIS | diagnostic | coronary heart disease | 0 | Main | |
| 4139AA | OXMIS | ANGINA ATTACK | diagnostic | coronary heart disease | 0 | Sensitivity | |
| 4139AT | OXMIS | ANGINA ATYPICAL | diagnostic | coronary heart disease | 0 | Main | |
| 4139C | OXMIS | CARDIAC ANGINA | diagnostic | coronary heart disease | 0 | Main | |
| 4139CO | OXMIS | ANGINA CRESCENDO | diagnostic | coronary heart disease | 0 | Main | |
| 4139E | OXMIS | ANGINA EFFORT | diagnostic | coronary heart disease | 0 | Main | |
| 4139M | OXMIS | SYNDROME ANGINAL | diagnostic | coronary heart disease | 0 | Main | |
| 4139N | OXMIS | ANGINA | diagnostic | coronary heart disease | 0 | Main | |
| 4139PA | OXMIS | ANGINA INVERSA | diagnostic | coronary heart disease | 0 | Main | |
| 4139U | OXMIS | UNSTABLE ANGINA | diagnostic | coronary heart disease | 0 | Main | |
| 4149 | OXMIS | ASYMPTOMATIC ISCHAEMIC HEART DISEASE | diagnostic | coronary heart disease | 0 | Main |
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