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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: dementia
96 codes in list
| Code | Coding system | Description | Entity type | List name | QOF | analysis | |
|---|---|---|---|---|---|---|---|
| 3AE..00 | Read | Global deterioration scale: assessment of prim deg dementia | diagnostic | dementia | 0 | Sensitivity | |
| 66h..00 | Read | Dementia monitoring | diagnostic | dementia | 0 | Sensitivity | |
| 6AB..00 | Read | Dementia annual review | diagnostic | dementia | 0 | Sensitivity | |
| E00..00 | Read | Senile and presenile organic psychotic conditions | diagnostic | dementia | 1 | Main | |
| e000.00 | Read | Uncomplicated senile dementia | diagnostic | dementia | 1 | Main | |
| E000.00 | Read | Uncomplicated senile dementia | diagnostic | dementia | 1 | Main | |
| E001.00 | Read | Presenile dementia | diagnostic | dementia | 1 | Main | |
| E001000 | Read | Uncomplicated presenile dementia | diagnostic | dementia | 1 | Main | |
| E00..11 | Read | Senile dementia | diagnostic | dementia | 1 | Main | |
| E001100 | Read | Presenile dementia with delirium | diagnostic | dementia | 1 | Main | |
| E00..12 | Read | Senile/presenile dementia | diagnostic | dementia | 1 | Main | |
| E001200 | Read | Presenile dementia with paranoia | diagnostic | dementia | 1 | Main | |
| E001300 | Read | Presenile dementia with depression | diagnostic | dementia | 1 | Main | |
| E001z00 | Read | Presenile dementia NOS | diagnostic | dementia | 1 | Main | |
| E002.00 | Read | Senile dementia with depressive or paranoid features | diagnostic | dementia | 1 | Main | |
| E002000 | Read | Senile dementia with paranoia | diagnostic | dementia | 1 | Main | |
| E002100 | Read | Senile dementia with depression | diagnostic | dementia | 1 | Main | |
| E002z00 | Read | Senile dementia with depressive or paranoid features NOS | diagnostic | dementia | 1 | Main | |
| E003.00 | Read | Senile dementia with delirium | diagnostic | dementia | 1 | Main | |
| E004.00 | Read | Arteriosclerotic dementia | diagnostic | dementia | 1 | Main | |
| E004000 | Read | Uncomplicated arteriosclerotic dementia | diagnostic | dementia | 1 | Main | |
| E004100 | Read | Arteriosclerotic dementia with delirium | diagnostic | dementia | 1 | Main | |
| E004.11 | Read | Multi infarct dementia | diagnostic | dementia | 1 | Main | |
| E004200 | Read | Arteriosclerotic dementia with paranoia | diagnostic | dementia | 1 | Main | |
| E004300 | Read | Arteriosclerotic dementia with depression | diagnostic | dementia | 1 | Main | |
| E004z00 | Read | Arteriosclerotic dementia NOS | diagnostic | dementia | 1 | Main | |
| E00y.00 | Read | Other senile and presenile organic psychoses | diagnostic | dementia | 1 | Main | |
| E00y.11 | Read | Presbyophrenic psychosis | diagnostic | dementia | 1 | Main | |
| E00z.00 | Read | Senile or presenile psychoses NOS | diagnostic | dementia | 1 | Main | |
| E012.00 | Read | Other alcoholic dementia | diagnostic | dementia | 1 | Main | |
| E012000 | Read | Chronic alcoholic brain syndrome | diagnostic | dementia | 1 | Main | |
| E012.11 | Read | Alcoholic dementia NOS | diagnostic | dementia | 1 | Main | |
| E041.00 | Read | Dementia in conditions EC | diagnostic | dementia | 1 | Main | |
| Eu00.00 | Read | [X]Dementia in Alzheimer's disease | diagnostic | dementia | 1 | Main | |
| Eu00000 | Read | [X]Dementia in Alzheimer's disease with early onset | diagnostic | dementia | 1 | Main | |
| Eu00011 | Read | [X]Presenile dementia;Alzheimer's type | diagnostic | dementia | 1 | Main | |
| Eu00012 | Read | [X]Primary degen dementia; Alzheimer's type; presenile onset | diagnostic | dementia | 1 | Main | |
| Eu00013 | Read | [X]Alzheimer's disease type 2 | diagnostic | dementia | 1 | Main | |
| Eu00100 | Read | [X]Dementia in Alzheimer's disease with late onset | diagnostic | dementia | 1 | Main | |
| Eu00111 | Read | [X]Alzheimer's disease type 1 | diagnostic | dementia | 1 | Main | |
| Eu00112 | Read | [X]Senile dementia;Alzheimer's type | diagnostic | dementia | 1 | Main | |
| Eu00113 | Read | [X]Primary degen dementia of Alzheimer's type; senile onset | diagnostic | dementia | 1 | Main | |
| Eu00200 | Read | [X]Dementia in Alzheimer's dis; atypical or mixed type | diagnostic | dementia | 1 | Main | |
| Eu00z00 | Read | [X]Dementia in Alzheimer's disease; unspecified | diagnostic | dementia | 1 | Main | |
| Eu00z11 | Read | [X]Alzheimer's dementia unspec | diagnostic | dementia | 1 | Main | |
| Eu01.00 | Read | [X]Vascular dementia | diagnostic | dementia | 1 | Main | |
| Eu01000 | Read | [X]Vascular dementia of acute onset | diagnostic | dementia | 1 | Main | |
| Eu01100 | Read | [X]Multi-infarct dementia | diagnostic | dementia | 1 | Main | |
| Eu01.11 | Read | [X]Arteriosclerotic dementia | diagnostic | dementia | 1 | Main | |
| Eu01111 | Read | [X]Predominantly cortical dementia | diagnostic | dementia | 1 | Main | |
| Eu01200 | Read | [X]Subcortical vascular dementia | diagnostic | dementia | 1 | Main | |
| Eu01300 | Read | [X]Mixed cortical and subcortical vascular dementia | diagnostic | dementia | 1 | Main | |
| Eu01y00 | Read | [X]Other vascular dementia | diagnostic | dementia | 1 | Main | |
| Eu01z00 | Read | [X]Vascular dementia; unspecified | diagnostic | dementia | 1 | Main | |
| Eu02.00 | Read | [X]Dementia in other diseases classified elsewhere | diagnostic | dementia | 1 | Main | |
| Eu02000 | Read | [X]Dementia in Pick's disease | diagnostic | dementia | 1 | Main | |
| Eu02100 | Read | [X]Dementia in Creutzfeldt-Jakob disease | diagnostic | dementia | 1 | Main | |
| Eu02200 | Read | [X]Dementia in Huntington's disease | diagnostic | dementia | 1 | Main | |
| Eu02300 | Read | [X]Dementia in Parkinson's disease | diagnostic | dementia | 1 | Main | |
| Eu02400 | Read | [X]Dementia in human immunodef virus [HIV] disease | diagnostic | dementia | 1 | Main | |
| Eu02500 | Read | [X]Lewy body dementia | diagnostic | dementia | 1 | Main | |
| Eu02y00 | Read | [X]Dementia in other specified diseases classif elsewhere | diagnostic | dementia | 1 | Main | |
| Eu02z00 | Read | [X] Unspecified dementia | diagnostic | dementia | 1 | Main | |
| Eu02z11 | Read | [X] Presenile dementia NOS | diagnostic | dementia | 1 | Main | |
| Eu02z12 | Read | [X] Presenile psychosis NOS | diagnostic | dementia | 1 | Main | |
| Eu02z13 | Read | [X] Primary degenerative dementia NOS | diagnostic | dementia | 1 | Main | |
| Eu02z14 | Read | [X] Senile dementia NOS | diagnostic | dementia | 1 | Main | |
| Eu02z15 | Read | [X] Senile psychosis NOS | diagnostic | dementia | 1 | Main | |
| Eu02z16 | Read | [X] Senile dementia; depressed or paranoid type | diagnostic | dementia | 1 | Main | |
| Eu04100 | Read | [X]Delirium superimposed on dementia | diagnostic | dementia | 1 | Sensitivity | |
| Eu10711 | Read | [X]Alcoholic dementia NOS | diagnostic | dementia | 0 | Main | |
| F110.00 | Read | Alzheimer's disease | diagnostic | dementia | 1 | Main | |
| F110000 | Read | Alzheimer's disease with early onset | diagnostic | dementia | 1 | Main | |
| F110100 | Read | Alzheimer's disease with late onset | diagnostic | dementia | 1 | Main | |
| F111.00 | Read | Pick's disease | diagnostic | dementia | 1 | Main | |
| F112.00 | Read | Senile degeneration of brain | diagnostic | dementia | 1 | Main | |
| F116.00 | Read | Lewy body disease | diagnostic | dementia | 1 | Main | |
| Fyu3000 | Read | [X]Other Alzheimer's disease | diagnostic | dementia | 0 | Main | |
| ZR1K.00 | Read | Alzheimer's disease assessment scale | diagnostic | dementia | 0 | Sensitivity | |
| ZR1K.11 | Read | ADAS - Alzheimer's disease assessment scale | diagnostic | dementia | 0 | Sensitivity | |
| ZR2X.12 | Read | BDRS - Blessed dementia rating scale | diagnostic | dementia | 0 | Sensitivity | |
| ZR3V.00 | Read | Clinical dementia rating scale | diagnostic | dementia | 0 | Sensitivity | |
| ZR3V.11 | Read | DRS - Clinical dementia rating scale | diagnostic | dementia | 0 | Sensitivity | |
| ZR3V.12 | Read | CDR - Clinical dementia rating scale | diagnostic | dementia | 0 | Sensitivity | |
| ZR3V.13 | Read | Dementia rating scale | diagnostic | dementia | 0 | Sensitivity | |
| ZS7C500 | Read | Language disorder of dementia | diagnostic | dementia | 0 | Sensitivity | |
| 2900 | OXMIS | SENILE DEMENTIA | diagnostic | dementia | 0 | Main | |
| 2901A | OXMIS | PRESENILE DEMENTIA | diagnostic | dementia | 0 | Main | |
| 2901B | OXMIS | ALZHEIMER'S DISEASE | diagnostic | dementia | 0 | Main | |
| 2901D | OXMIS | JACOB- CREUZFELDT DISEASE WITH DEMENTIA | diagnostic | dementia | 0 | Main | |
| 2919 | OXMIS | DEMENTIA ALCOHOLIC | diagnostic | dementia | 0 | Main | |
| 2930 | OXMIS | DEMENTIA ARTERIOSCLEROTIC | diagnostic | dementia | 0 | Main | |
| 299 B | OXMIS | DEMENTIA | diagnostic | dementia | 0 | Main | |
| 299 G | OXMIS | DEMENTIA AGGRESSIVE | diagnostic | dementia | 0 | Main | |
| Y0601JS | OXMIS | DEMENTIA CLINIC ATTENDANCE | diagnostic | dementia | 0 | Sensitivity | |
| Y060 JS | OXMIS | DEMENTIA CLINIC | diagnostic | dementia | 0 | Sensitivity |
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