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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: osteoarthritis

59 codes in list

Code Coding system Description Entity type List name analysis
585O.00 Read Quantitative ultrasound scan of heel - result osteoporotic diagnostic osteoarthritis Main
58E4.00 Read Forearm DXA scan result osteoporotic diagnostic osteoarthritis Main
58EA.00 Read Heel DXA scan result osteoporotic diagnostic osteoarthritis Main
58EG.00 Read Hip DXA scan result osteoporotic diagnostic osteoarthritis Main
58EM.00 Read Lumbar DXA scan result osteoporotic diagnostic osteoarthritis Main
66a..00 Read Osteoporosis monitoring diagnostic osteoarthritis Sensitivity
66a2.00 Read Osteoporosis treatment started diagnostic osteoarthritis Sensitivity
66a3.00 Read Osteoporosis treatment stopped diagnostic osteoarthritis Sensitivity
66a4.00 Read Osteoporosis treatment changed diagnostic osteoarthritis Sensitivity
66a6.00 Read Osteoporosis - dietary advice diagnostic osteoarthritis Sensitivity
66a7.00 Read Osteoporosis - dietary assessment diagnostic osteoarthritis Sensitivity
66a8.00 Read Osteoporosis - exercise advice diagnostic osteoarthritis Sensitivity
66a9.00 Read Osteoporosis - falls prevention diagnostic osteoarthritis Sensitivity
66aA.00 Read Osteoporosis - treatment response diagnostic osteoarthritis Sensitivity
66aE.00 Read Refer to osteoporosis specialist diagnostic osteoarthritis Sensitivity
7230A Read OSTEOPOROSIS diagnostic osteoarthritis Main
7230B Read OSTEOPOROSIS SENILIS diagnostic osteoarthritis Main
7230D Read VERTEBRAL OSTEOPOROSIS diagnostic osteoarthritis Main
7230PM Read OSTEOPOROSIS POSTMENOPAUSAL diagnostic osteoarthritis Main
7230PT Read OSTEOPOROSIS POST-TRAUMATIC diagnostic osteoarthritis Main
8HTS.00 Read Referral to osteoporosis clinic diagnostic osteoarthritis Sensitivity
9N0h.00 Read Seen in osteoporosis clinic diagnostic osteoarthritis Sensitivity
9Od0.00 Read Attends osteoporosis monitoring diagnostic osteoarthritis Sensitivity
N330.00 Read Osteoporosis diagnostic osteoarthritis Main
N330000 Read Osteoporosis; unspecified diagnostic osteoarthritis Main
N330100 Read Senile osteoporosis diagnostic osteoarthritis Main
N330200 Read Postmenopausal osteoporosis diagnostic osteoarthritis Main
N330300 Read Idiopathic osteoporosis diagnostic osteoarthritis Main
N330400 Read Dissuse osteoporosis diagnostic osteoarthritis Main
N330500 Read Drug-induced osteoporosis diagnostic osteoarthritis Main
N330600 Read Postoophorectomy osteoporosis diagnostic osteoarthritis Main
N330700 Read Postsurgical malabsorption osteoporosis diagnostic osteoarthritis Main
N330800 Read Localized osteoporosis - Lequesne diagnostic osteoarthritis Main
N330900 Read Osteoporosis in multiple myelomatosis diagnostic osteoarthritis Main
N330A00 Read Osteoporosis in endocrine disorders diagnostic osteoarthritis Main
N330B00 Read Vertebral osteoporosis diagnostic osteoarthritis Main
N330C00 Read Osteoporosis localized to spine diagnostic osteoarthritis Main
N330D00 Read Osteoporosis due to corticosteroids diagnostic osteoarthritis Main
N330z00 Read Osteoporosis NOS diagnostic osteoarthritis Main
N331.14 Read Osteoporotic vertebral collapse diagnostic osteoarthritis Sensitivity
N331200 Read Postoophorectomy osteoporosis with pathological fracture diagnostic osteoarthritis Main
N331300 Read Osteoporosis of disuse with pathological fracture diagnostic osteoarthritis Main
N331400 Read Postsurgical malabsorption osteoporosis with path fracture diagnostic osteoarthritis Main
N331500 Read Drug-induced osteoporosis with pathological fracture diagnostic osteoarthritis Main
N331600 Read Idiopathic osteoporosis with pathological fracture diagnostic osteoarthritis Main
N331800 Read Osteoporosis + pathological fracture lumbar vertebrae diagnostic osteoarthritis Main
N331900 Read Osteoporosis + pathological fracture thoracic vertebrae diagnostic osteoarthritis Main
N331A00 Read Osteoporosis + pathological fracture cervical vertebrae diagnostic osteoarthritis Main
N331B00 Read Postmenopausal osteoporosis with pathological fracture diagnostic osteoarthritis Main
N331H00 Read Collapse of cervical vertebra due to osteoporosis diagnostic osteoarthritis Sensitivity
N331J00 Read Collapse of lumbar vertebra due to osteoporosis diagnostic osteoarthritis Sensitivity
N331K00 Read Collapse of thoracic vertebra due to osteoporosis diagnostic osteoarthritis Sensitivity
N331L00 Read Collapse of vertebra due to osteoporosis NOS diagnostic osteoarthritis Sensitivity
N331M00 Read Fragility fracture due to unspecified osteoporosis diagnostic osteoarthritis Sensitivity
N374600 Read Osteoporotic kyphosis diagnostic osteoarthritis Sensitivity
NyuB000 Read [X]Other osteoporosis with pathological fracture diagnostic osteoarthritis Main
NyuB100 Read [X]Other osteoporosis diagnostic osteoarthritis Main
NyuB200 Read [X]Osteoporosis in other disorders classified elsewhere diagnostic osteoarthritis Main
NyuB800 Read [X]Unspecified osteoporosis with pathological fracture diagnostic osteoarthritis Main

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