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