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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: depression

212 codes in list

Code Coding system Description Entity type List name QOF analysis screened
1465.00 Read H/O: depression diagnostic depression 0 Sensitivity 0
1B17.00 Read Depressed diagnostic depression 0 0
1B17.00 Read Depressed diagnostic depression 0 Main 0
1B17.11 Read C/O - feeling depressed diagnostic depression 0 Sensitivity 1
1B1U.00 Read Symptoms of depression diagnostic depression 0 Sensitivity 1
1B1U.11 Read Depressive symptoms diagnostic depression 0 Sensitivity 1
1BT..00 Read Depressed mood diagnostic depression 0 Sensitivity 1
212S.00 Read Depression resolved diagnostic depression 0 Resolve 0
212S.00 Read Depression resolved diagnostic depression 1 0
2257 Read O/E - depressed diagnostic depression 0 0
2257.00 Read O/E - depressed diagnostic depression 0 Main 0
62T1.00 Read Puerperal depression diagnostic depression 0 Main 0
62T1.00 Read Puerperal depression diagnostic depression 0 0
8CAa.00 Read Patient given advice about management of depression diagnostic depression 0 Sensitivity 1
8HHq.00 Read Referral for guided self-help for depression diagnostic depression 0 Sensitivity 1
9H90.00 Read Depression annual review diagnostic depression 0 Sensitivity 1
9H91.00 Read Depression medication review diagnostic depression 0 Sensitivity 1
9H92.00 Read Depression interim review diagnostic depression 0 Sensitivity 1
9HA0.00 Read On depression register diagnostic depression 0 Sensitivity 1
9HA1.00 Read Removed from depression register diagnostic depression 1 0
9HA1.00 Read Removed from depression register diagnostic depression 0 Resolve 0
E001300 Read Presenile dementia with depression diagnostic depression 1 Main 0
E001300 Read Presenile dementia with depression diagnostic depression 0 0
E002100 Read Senile dementia with depression diagnostic depression 1 Main 0
E002100 Read Senile dementia with depression diagnostic depression 0 0
E004300 Read Arteriosclerotic dementia with depression diagnostic depression 0 Main 0
E004300 Read Arteriosclerotic dementia with depression diagnostic depression 0 0
E112.00 Read Single major depressive episode diagnostic depression 0 0
E112.00 Read Single major depressive episode diagnostic depression 1 Main 0
E112000 Read Single major depressive episode; unspecified diagnostic depression 1 Main 0
E112000 Read Single major depressive episode; unspecified diagnostic depression 0 0
E112100 Read Single major depressive episode; mild diagnostic depression 0 0
E112100 Read Single major depressive episode; mild diagnostic depression 1 Main 0
E112.11 Read Agitated depression diagnostic depression 1 Main 0
E112.11 Read Agitated depression diagnostic depression 0 0
E112.12 Read Endogenous depression first episode diagnostic depression 0 0
E112.12 Read Endogenous depression first episode diagnostic depression 1 Main 0
E112.13 Read Endogenous depression first episode diagnostic depression 0 0
E112.13 Read Endogenous depression first episode diagnostic depression 1 Main 0
E112.14 Read Endogenous depression diagnostic depression 0 0
E112.14 Read Endogenous depression diagnostic depression 1 Main 0
E112200 Read Single major depressive episode; moderate diagnostic depression 1 Main 0
E112200 Read Single major depressive episode; moderate diagnostic depression 0 0
E112300 Read Single major depressive episode; severe; without psychosis diagnostic depression 0 0
E112300 Read Single major depressive episode; severe; without psychosis diagnostic depression 1 Main 0
E112500 Read Single major depressive episode; partial or unspec remission diagnostic depression 1 0
E112500 Read Single major depressive episode; partial or unspec remission diagnostic depression 1 Resolve 0
E112600 Read Single major depressive episode; in full remission diagnostic depression 1 Resolve 0
E112600 Read Single major depressive episode; in full remission diagnostic depression 1 0
E112z00 Read Single major depressive episode NOS diagnostic depression 1 Main 0
E112z00 Read Single major depressive episode NOS diagnostic depression 0 0
E113.00 Read Recurrent major depressive episode diagnostic depression 0 1
E113.00 Read Recurrent major depressive episode diagnostic depression 1 Main 0
E113000 Read Recurrent major depressive episodes; unspecified diagnostic depression 1 Main 0
E113000 Read Recurrent major depressive episodes; unspecified diagnostic depression 0 1
E113100 Read Recurrent major depressive episodes; mild diagnostic depression 1 Main 0
E113100 Read Recurrent major depressive episodes; mild diagnostic depression 0 1
E113.11 Read Endogenous depression - recurrent diagnostic depression 1 Main 0
E113.11 Read Endogenous depression - recurrent diagnostic depression 0 1
E113200 Read Recurrent major depressive episodes; moderate diagnostic depression 1 Main 0
E113200 Read Recurrent major depressive episodes; moderate diagnostic depression 0 1
E113300 Read Recurrent major depressive episodes; severe; no psychosis diagnostic depression 0 1
E113300 Read Recurrent major depressive episodes; severe; no psychosis diagnostic depression 1 Main 0
E113500 Read Recurrent major depressive episodes;partial/unspec remission diagnostic depression 1 1
E113500 Read Recurrent major depressive episodes;partial/unspec remission diagnostic depression 1 Resolve 0
E113600 Read Recurrent major depressive episodes; in full remission diagnostic depression 1 Resolve 0
E113600 Read Recurrent major depressive episodes; in full remission diagnostic depression 1 1
E113700 Read Recurrent depression diagnostic depression 1 Main 0
E113700 Read Recurrent depression diagnostic depression 0 1
E113z00 Read Recurrent major depressive episode NOS diagnostic depression 1 Main 0
E113z00 Read Recurrent major depressive episode NOS diagnostic depression 0 1
E118.00 Read Seasonal affective disorder diagnostic depression 1 Main 0
E118.00 Read Seasonal affective disorder diagnostic depression 0 1
E11y200 Read Atypical depressive disorder diagnostic depression 0 0
E11y200 Read Atypical depressive disorder diagnostic depression 1 Main 0
E11z200 Read Masked depression diagnostic depression 1 Main 0
E11z200 Read Masked depression diagnostic depression 0 0
E135.00 Read Agitated depression diagnostic depression 0 0
E135.00 Read Agitated depression diagnostic depression 1 Main 0
E200300 Read Anxiety with depression diagnostic depression 0 0
E200300 Read Anxiety with depression diagnostic depression 1 Main 0
E204.00 Read Neurotic depression reactive type diagnostic depression 0 0
E204.00 Read Neurotic depression reactive type diagnostic depression 0 Main 0
E204.11 Read Postnatal depression diagnostic depression 0 Main 0
E204.11 Read Postnatal depression diagnostic depression 0 0
E211200 Read Depressive personality disorder diagnostic depression 0 Sensitivity 0
E290.00 Read Brief depressive reaction diagnostic depression 0 Main 0
E290.00 Read Brief depressive reaction diagnostic depression 0 0
E290z00 Read Brief depressive reaction NOS diagnostic depression 0 0
E290z00 Read Brief depressive reaction NOS diagnostic depression 0 Main 0
E291.00 Read Prolonged depressive reaction diagnostic depression 0 1
E291.00 Read Prolonged depressive reaction diagnostic depression 1 Main 0
E2B..00 Read Depressive disorder NEC diagnostic depression 0 0
E2B..00 Read Depressive disorder NEC diagnostic depression 0 Main 0
E2B0.00 Read Postviral depression diagnostic depression 0 Main 0
E2B0.00 Read Postviral depression diagnostic depression 0 0
E2B1.00 Read Chronic depression diagnostic depression 0 1
E2B1.00 Read Chronic depression diagnostic depression 0 Main 0
Eu32.00 Read [X]Depressive episode diagnostic depression 1 Main 0
Eu32.00 Read [X]Depressive episode diagnostic depression 0 0
Eu32000 Read [X]Mild depressive episode diagnostic depression 0 Main 0
Eu32000 Read [X]Mild depressive episode diagnostic depression 0 0
Eu32100 Read [X]Moderate depressive episode diagnostic depression 0 0
Eu32100 Read [X]Moderate depressive episode diagnostic depression 0 Main 0
Eu32.11 Read [X]Single episode of depressive reaction diagnostic depression 1 Main 0
Eu32.11 Read [X]Single episode of depressive reaction diagnostic depression 0 0
Eu32.12 Read [X]Single episode of psychogenic depression diagnostic depression 1 Main 0
Eu32.12 Read [X]Single episode of psychogenic depression diagnostic depression 0 0
Eu32.13 Read [X]Single episode of reactive depression diagnostic depression 0 0
Eu32.13 Read [X]Single episode of reactive depression diagnostic depression 1 Main 0
Eu32200 Read [X]Severe depressive episode without psychotic symptoms diagnostic depression 0 0
Eu32200 Read [X]Severe depressive episode without psychotic symptoms diagnostic depression 0 Main 0
Eu32211 Read [X]Single episode agitated depressn w'out psychotic symptoms diagnostic depression 0 Main 0
Eu32211 Read [X]Single episode agitated depressn w'out psychotic symptoms diagnostic depression 0 0
Eu32212 Read [X]Single episode major depression w'out psychotic symptoms diagnostic depression 0 Main 0
Eu32212 Read [X]Single episode major depression w'out psychotic symptoms diagnostic depression 0 0
Eu32213 Read [X]Single episode vital depression w'out psychotic symptoms diagnostic depression 0 0
Eu32213 Read [X]Single episode vital depression w'out psychotic symptoms diagnostic depression 0 Main 0
Eu32400 Read [X]Mild depression diagnostic depression 0 Main 0
Eu32400 Read [X]Mild depression diagnostic depression 0 0
Eu32y00 Read [X]Other depressive episodes diagnostic depression 0 Main 0
Eu32y00 Read [X]Other depressive episodes diagnostic depression 0 0
Eu32y11 Read [X]Atypical depression diagnostic depression 0 0
Eu32y11 Read [X]Atypical depression diagnostic depression 0 Main 0
Eu32y12 Read [X]Single episode of masked depression NOS diagnostic depression 0 Main 0
Eu32y12 Read [X]Single episode of masked depression NOS diagnostic depression 0 0
Eu32z00 Read [X]Depressive episode; unspecified diagnostic depression 0 Main 0
Eu32z00 Read [X]Depressive episode; unspecified diagnostic depression 0 0
Eu32z11 Read [X]Depression NOS diagnostic depression 0 0
Eu32z11 Read [X]Depression NOS diagnostic depression 0 Main 0
Eu32z12 Read [X]Depressive disorder NOS diagnostic depression 0 Main 0
Eu32z12 Read [X]Depressive disorder NOS diagnostic depression 0 0
Eu32z13 Read [X]Prolonged single episode of reactive depression diagnostic depression 0 Main 0
Eu32z13 Read [X]Prolonged single episode of reactive depression diagnostic depression 0 0
Eu32z14 Read [X] Reactive depression NOS diagnostic depression 0 0
Eu32z14 Read [X] Reactive depression NOS diagnostic depression 0 Main 0
Eu33.00 Read [X]Recurrent depressive disorder diagnostic depression 1 Main 0
Eu33.00 Read [X]Recurrent depressive disorder diagnostic depression 0 1
Eu33000 Read [X]Recurrent depressive disorder; current episode mild diagnostic depression 1 Main 0
Eu33000 Read [X]Recurrent depressive disorder; current episode mild diagnostic depression 0 1
Eu33100 Read [X]Recurrent depressive disorder; current episode moderate diagnostic depression 1 Main 0
Eu33100 Read [X]Recurrent depressive disorder; current episode moderate diagnostic depression 0 1
Eu33.11 Read [X]Recurrent episodes of depressive reaction diagnostic depression 1 Main 0
Eu33.11 Read [X]Recurrent episodes of depressive reaction diagnostic depression 0 1
Eu33.12 Read [X]Recurrent episodes of psychogenic depression diagnostic depression 1 Main 0
Eu33.12 Read [X]Recurrent episodes of psychogenic depression diagnostic depression 0 1
Eu33.13 Read [X]Recurrent episodes of reactive depression diagnostic depression 0 1
Eu33.13 Read [X]Recurrent episodes of reactive depression diagnostic depression 1 Main 0
Eu33.14 Read [X]Seasonal depressive disorder diagnostic depression 1 Main 0
Eu33.14 Read [X]Seasonal depressive disorder diagnostic depression 0 1
Eu33.15 Read [X]SAD - Seasonal affective disorder diagnostic depression 0 1
Eu33.15 Read [X]SAD - Seasonal affective disorder diagnostic depression 1 Main 0
Eu33200 Read [X]Recurr depress disorder cur epi severe without psyc sympt diagnostic depression 1 Main 0
Eu33200 Read [X]Recurr depress disorder cur epi severe without psyc sympt diagnostic depression 0 1
Eu33211 Read [X]Endogenous depression without psychotic symptoms diagnostic depression 1 Main 0
Eu33211 Read [X]Endogenous depression without psychotic symptoms diagnostic depression 0 0
Eu33212 Read [X]Major depression; recurrent without psychotic symptoms diagnostic depression 0 1
Eu33212 Read [X]Major depression; recurrent without psychotic symptoms diagnostic depression 1 Main 0
Eu33214 Read [X]Vital depression; recurrent without psychotic symptoms diagnostic depression 0 1
Eu33214 Read [X]Vital depression; recurrent without psychotic symptoms diagnostic depression 1 Main 0
Eu33400 Read [X]Recurrent depressive disorder; currently in remission diagnostic depression 1 Main 0
Eu33400 Read [X]Recurrent depressive disorder; currently in remission diagnostic depression 0 1
Eu33y00 Read [X]Other recurrent depressive disorders diagnostic depression 0 1
Eu33y00 Read [X]Other recurrent depressive disorders diagnostic depression 1 Main 0
Eu33z00 Read [X]Recurrent depressive disorder; unspecified diagnostic depression 0 1
Eu33z00 Read [X]Recurrent depressive disorder; unspecified diagnostic depression 1 Main 0
Eu33z11 Read [X]Monopolar depression NOS diagnostic depression 1 Main 0
Eu33z11 Read [X]Monopolar depression NOS diagnostic depression 0 0
Eu34100 Read [X]Dysthymia diagnostic depression 1 Main 0
Eu34100 Read [X]Dysthymia diagnostic depression 0 0
Eu34111 Read [X]Depressive neurosis diagnostic depression 0 Main 0
Eu34111 Read [X]Depressive neurosis diagnostic depression 0 0
Eu34113 Read [X]Neurotic depression diagnostic depression 0 0
Eu34113 Read [X]Neurotic depression diagnostic depression 0 Main 0
Eu34114 Read [X]Persistant anxiety depression diagnostic depression 0 Main 0
Eu34114 Read [X]Persistant anxiety depression diagnostic depression 0 1
Eu3y111 Read [X]Recurrent brief depressive episodes diagnostic depression 0 Main 0
Eu3y111 Read [X]Recurrent brief depressive episodes diagnostic depression 0 1
Eu41200 Read [X]Mixed anxiety and depressive disorder diagnostic depression 1 Main 0
Eu41200 Read [X]Mixed anxiety and depressive disorder diagnostic depression 0 0
Eu41211 Read [X]Mild anxiety depression diagnostic depression 0 0
Eu41211 Read [X]Mild anxiety depression diagnostic depression 0 Main 0
Eu53011 Read [X]Postnatal depression NOS diagnostic depression 0 Main 0
Eu53011 Read [X]Postnatal depression NOS diagnostic depression 0 0
Eu53012 Read [X]Postpartum depression NOS diagnostic depression 0 0
Eu53012 Read [X]Postpartum depression NOS diagnostic depression 0 Main 0
Eu92000 Read [X]Depressive conduct disorder diagnostic depression 0 Main 0
Eu92000 Read [X]Depressive conduct disorder diagnostic depression 0 0
2960AC OXMIS CHRONIC AGITATED DEPRESSION diagnostic depression 0 Main 0
2960AD OXMIS DEPRESSION AGITATED diagnostic depression 0 Main 0
2962A OXMIS DEPRESSION CHRONIC diagnostic depression 0 Main 0
2962AF OXMIS REACTION DEPRESSIVE AFFECTIVE diagnostic depression 0 Main 0
2962B OXMIS DEPRESSION ACUTE diagnostic depression 0 Main 0
2962EN OXMIS ENDOGENOUS DEPRESSION diagnostic depression 0 Main 0
2962R OXMIS RECURRENT DEPRESSION diagnostic depression 0 Main 0
3000E OXMIS ANXIETY DEPRESSION diagnostic depression 0 Main 0
3004 OXMIS NEUROSIS DEPRESSIVE diagnostic depression 0 Main 0
3004A OXMIS DEPRESSION diagnostic depression 0 Main 0
3004AB OXMIS OBSERVED DEPRESSION diagnostic depression 0 Main 0
3004AM OXMIS MOOD DEPRESSED diagnostic depression 0 Main 0
3004B OXMIS PREGNANCY DEPRESSION diagnostic depression 0 Main 0
3004C OXMIS PUERPERAL DEPRESSION diagnostic depression 0 Main 0
3004CA OXMIS POSTNATAL DEPRESSION diagnostic depression 0 Main 0
3004E OXMIS EXOGENOUS DEPRESSION diagnostic depression 0 Main 0
3004ER OXMIS REACTIVE DEPRESSION diagnostic depression 0 Main 0
3004M OXMIS MORNING DEPRESSION diagnostic depression 0 Main 0
3004PP OXMIS POSTOPERATIVE DEPRESSION diagnostic depression 0 Main 0
3091N OXMIS INFLUENZAL DEPRESSION diagnostic depression 0 Main 0
3091PF OXMIS POSTINFECTIVE DEPRESSION diagnostic depression 0 Main 0
3091PL OXMIS DEPRESSION POSTVIRAL diagnostic depression 0 Main 0
3091PN OXMIS POSTINFLUENZA DEPRESSION diagnostic depression 0 Main 0
7902DC OXMIS POSTVIRAL DEPRESSION diagnostic depression 0 Main 0

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