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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: Heart failure / LVD
72 codes in list
| Code | Coding system | Description | Entity type | List name | QOF | HF_analysis | LVD_analysis |
|---|---|---|---|---|---|---|---|
| 14A6.00 | Read | H/O: heart failure | diagnostic | Heart failure / LVD | LVD | Sensitivity | |
| 14AM.00 | Read | H/O: Heart failure in last year | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 1O1..00 | Read | Heart failure confirmed | diagnostic | Heart failure / LVD | 0 | Main | |
| 585f.00 | Read | Echocardiogram shows left ventricular systolic dysfunction | diagnostic | Heart failure / LVD | HF/LVD | Main | |
| 585g.00 | Read | Echocardiogram shows left ventricular diastolic dysfunction | diagnostic | Heart failure / LVD | HF/LVD | Main | |
| 662f.00 | Read | New York Heart Association classification - class I | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 662g.00 | Read | New York Heart Association classification - class II | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 662h.00 | Read | New York Heart Association classification - class III | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 662i.00 | Read | New York Heart Association classification - class IV | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 662p.00 | Read | Heart failure 6 month review | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 662T.00 | Read | Congestive heart failure monitoring | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 662W.00 | Read | Heart failure annual review | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 8B29.00 | Read | Cardiac failure therapy | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 8CL3.00 | Read | Heart failure care plan discussed with patient | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 8H2S.00 | Read | Admit heart failure emergency | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 8HBE.00 | Read | Heart failure follow-up | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 8HHb.00 | Read | Referral to heart failure nurse | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 8HHz.00 | Read | Referral to heart failure exercise programme | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 8Hk0.00 | Read | Referred to heart failure education group | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 8HTL.00 | Read | Referral to heart failure clinic | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 9N0k.00 | Read | Seen in heart failure clinic | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 9N2p.00 | Read | Seen by community heart failure nurse | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 9N6T.00 | Read | Referred by heart failure nurse specialist | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| G1yz100 | Read | Rheumatic left ventricular failure | diagnostic | Heart failure / LVD | 0 | Main | Main |
| G232.00 | Read | Hypertensive heart&renal dis wth (congestive) heart failure | diagnostic | Heart failure / LVD | 0 | Main | |
| G234.00 | Read | Hyperten heart&renal dis+both(congestv)heart and renal fail | diagnostic | Heart failure / LVD | 0 | Main | |
| G58..00 | Read | Heart failure | diagnostic | Heart failure / LVD | 0 | Main | |
| G580.00 | Read | Congestive heart failure | diagnostic | Heart failure / LVD | 0 | Main | |
| G580000 | Read | Acute congestive heart failure | diagnostic | Heart failure / LVD | 0 | Main | |
| G580100 | Read | Chronic congestive heart failure | diagnostic | Heart failure / LVD | 0 | Main | |
| G580.11 | Read | Congestive cardiac failure | diagnostic | Heart failure / LVD | 0 | Main | |
| G580.12 | Read | Right heart failure | diagnostic | Heart failure / LVD | 0 | Main | |
| G580.13 | Read | Right ventricular failure | diagnostic | Heart failure / LVD | 0 | Main | |
| G580.14 | Read | Biventricular failure | diagnostic | Heart failure / LVD | 0 | Main | Main |
| G580200 | Read | Decompensated cardiac failure | diagnostic | Heart failure / LVD | 0 | Main | |
| G580300 | Read | Compensated cardiac failure | diagnostic | Heart failure / LVD | 0 | Main | |
| G581.00 | Read | Left ventricular failure | diagnostic | Heart failure / LVD | HF/LVD | Main | Main |
| G581000 | Read | Acute left ventricular failure | diagnostic | Heart failure / LVD | HF/LVD | Main | Main |
| G58..11 | Read | Cardiac failure | diagnostic | Heart failure / LVD | 0 | Main | |
| G581.11 | Read | Asthma - cardiac | diagnostic | Heart failure / LVD | HF/LVD | Main | Main |
| G581.12 | Read | Pulmonary oedema - acute | diagnostic | Heart failure / LVD | HF/LVD | Main | Main |
| G581.13 | Read | Impaired left ventricular function | diagnostic | Heart failure / LVD | HF/LVD | Main | Main |
| G582.00 | Read | Acute heart failure | diagnostic | Heart failure / LVD | 0 | Main | |
| G58z.00 | Read | Heart failure NOS | diagnostic | Heart failure / LVD | 0 | Main | |
| G58z.11 | Read | Weak heart | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| G58z.12 | Read | Cardiac failure NOS | diagnostic | Heart failure / LVD | 0 | Main | |
| G5y4z00 | Read | Post cardiac operation heart failure NOS | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| G5yy900 | Read | Left ventricular systolic dysfunction | diagnostic | Heart failure / LVD | HF/LVD | Main | |
| G5yyA00 | Read | Left ventricular diastolic dysfunction | diagnostic | Heart failure / LVD | HF/LVD | Main | |
| Q48y100 | Read | Congenital cardiac failure | diagnostic | Heart failure / LVD | 0 | Main | |
| Q490.00 | Read | Neonatal cardiac failure | diagnostic | Heart failure / LVD | 0 | Main | |
| SP11100 | Read | Cardiac insufficiency as a complication of care | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| SP11111 | Read | Heart failure as a complication of care | diagnostic | Heart failure / LVD | 0 | Sensitivity | |
| 402 C | OXMIS | HYPERTENSION CONGESTIVE HEART FAILURE | diagnostic | Heart failure / LVD | 0 | Main | |
| 4270 | OXMIS | CONGESTIVE HEART FAILURE | diagnostic | Heart failure / LVD | 0 | Main | |
| 4270BD | OXMIS | FAILURE RIGHT VENTRICULAR OBSTRUCTION SY | diagnostic | Heart failure / LVD | 0 | Main | |
| 4270BN | OXMIS | SYNDROME BERNHEIM'S | diagnostic | Heart failure / LVD | 0 | Main | |
| 4270BT | OXMIS | SYNDROME RIGHT VENTRICULAR OBSTRUCTION | diagnostic | Heart failure / LVD | 0 | Main | |
| 4270C | OXMIS | CONGESTIVE CARDIAC FAILURE | diagnostic | Heart failure / LVD | 0 | Main | |
| 4270CC | OXMIS | CONGESTIVE HEART FAILURE COMPENSATED | diagnostic | Heart failure / LVD | 0 | Main | |
| 4270D | OXMIS | CONGESTIVE HEART FAILURE DECOMPENSATED | diagnostic | Heart failure / LVD | 0 | Main | |
| 4270DR | OXMIS | DROPSY CARDIAC | diagnostic | Heart failure / LVD | 0 | Main | |
| 4270LW | OXMIS | SYNDROME LOW-OUTPUT | diagnostic | Heart failure / LVD | 0 | Main | |
| 4270R | OXMIS | HEART FAILURE RIGHT-SIDED | diagnostic | Heart failure / LVD | 0 | Main | |
| 4271 | OXMIS | LVF (LEFT VENTRICULAR FAILURE) | diagnostic | Heart failure / LVD | 0 | Main | Main |
| 4271A | OXMIS | LEFT VENTRICULAR FAILURE ACUTE | diagnostic | Heart failure / LVD | 0 | Main | Main |
| 4271H | OXMIS | HEART FAILURE LEFT-SIDED | diagnostic | Heart failure / LVD | 0 | Main | Main |
| 428 A | OXMIS | INSUFFICIENCY CARDIAC | diagnostic | Heart failure / LVD | 0 | Main | |
| 7824A | OXMIS | HIGH OUTPUT FAILURE (CARDIAC) | diagnostic | Heart failure / LVD | 0 | Main | |
| 7824AC | OXMIS | HEART FAILURE ACUTE | diagnostic | Heart failure / LVD | 0 | Main | |
| 7824FC | OXMIS | FAILURE CARDIAC | diagnostic | Heart failure / LVD | 0 | Main | |
| 7824FH | OXMIS | HEART FAILURE | diagnostic | Heart failure / LVD | 0 | Main |
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