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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: otitis media
69 codes in list
| Code | Coding system | Description | Entity type | List name | analysis | ||
|---|---|---|---|---|---|---|---|
| A552.00 | Read | Postmeasles otitis media | diagnostic | otitis media | Main | ||
| F51..00 | Read | Nonsuppurative otitis media + eustachian tube disorders | diagnostic | otitis media | Main | ||
| F510.00 | Read | Acute non suppurative otitis media | diagnostic | otitis media | Main | ||
| F510000 | Read | Acute otitis media with effusion | diagnostic | otitis media | Main | ||
| F510011 | Read | Acute secretory otitis media | diagnostic | otitis media | Main | ||
| F510100 | Read | Acute serous otitis media | diagnostic | otitis media | Main | ||
| F510200 | Read | Acute mucoid otitis media | diagnostic | otitis media | Main | ||
| F510300 | Read | Acute sanguinous otitis media | diagnostic | otitis media | Main | ||
| F510400 | Read | Acute allergic serous otitis media | diagnostic | otitis media | Main | ||
| F510500 | Read | Acute allergic mucoid otitis media | diagnostic | otitis media | Main | ||
| F510600 | Read | Acute allergic sanguinous otitis media | diagnostic | otitis media | Main | ||
| F510z00 | Read | Acute nonsuppurative otitis media NOS | diagnostic | otitis media | Main | ||
| F511.00 | Read | Chronic otitis media with effusion; serous | diagnostic | otitis media | Main | ||
| F511100 | Read | Serosanguinous chronic otitis media | diagnostic | otitis media | Main | ||
| F511.11 | Read | Chronic secretory otitis media; serous | diagnostic | otitis media | Main | ||
| F511z00 | Read | Chronic serous otitis media NOS | diagnostic | otitis media | Main | ||
| F512.00 | Read | Chronic otitis media with effusion; mucoid | diagnostic | otitis media | Main | ||
| F512100 | Read | Mucosanguinous chronic otitis media | diagnostic | otitis media | Main | ||
| F512.12 | Read | Chronic secretory otitis media; mucoid | diagnostic | otitis media | Main | ||
| F512z00 | Read | Chronic mucoid otitis media NOS | diagnostic | otitis media | Main | ||
| F513.00 | Read | Chronic otitis media with effusion; other | diagnostic | otitis media | Main | ||
| F513000 | Read | Chronic allergic otitis media | diagnostic | otitis media | Main | ||
| F513100 | Read | Chronic otitis media with effusion; purulent | diagnostic | otitis media | Main | ||
| F513111 | Read | Chronic secretory otitis media; purulent | diagnostic | otitis media | Main | ||
| F513z00 | Read | Other chronic nonsuppurative otitis media NOS | diagnostic | otitis media | Main | ||
| F514.00 | Read | Unspecified nonsuppurative otitis media | diagnostic | otitis media | Main | ||
| F514000 | Read | Allergic otitis media NOS | diagnostic | otitis media | Main | ||
| F514100 | Read | Serous otitis media NOS | diagnostic | otitis media | Main | ||
| F514200 | Read | Catarrhal otitis media NOS | diagnostic | otitis media | Main | ||
| F514300 | Read | Mucoid otitis media NOS | diagnostic | otitis media | Main | ||
| F514z00 | Read | Nonsuppurative otitis media NOS | diagnostic | otitis media | Main | ||
| F518.00 | Read | Chronic otitis media with effusion; unspecified | diagnostic | otitis media | Main | ||
| F52..00 | Read | Suppurative and unspecified otitis media | diagnostic | otitis media | Main | ||
| F520.00 | Read | Acute suppurative otitis media | diagnostic | otitis media | Main | ||
| F520000 | Read | Acute suppurative otitis media tympanic membrane intact | diagnostic | otitis media | Main | ||
| F520100 | Read | Acute suppurative otitis media tympanic membrane ruptured | diagnostic | otitis media | Main | ||
| F520300 | Read | Acute suppurative otitis media due to disease EC | diagnostic | otitis media | Main | ||
| F520z00 | Read | Acute suppurative otitis media NOS | diagnostic | otitis media | Main | ||
| F521.00 | Read | Chronic suppurative otitis media; tubotympanic | diagnostic | otitis media | Main | ||
| F522.00 | Read | Chronic suppurative otitis media; atticoantral | diagnostic | otitis media | Main | ||
| F523.00 | Read | Chronic suppurative otitis media NOS | diagnostic | otitis media | Main | ||
| F524.00 | Read | Purulent otitis media NOS | diagnostic | otitis media | Main | ||
| F524000 | Read | Bilateral suppurative otitis media | diagnostic | otitis media | Main | ||
| F525.00 | Read | Recurrent acute otitis media | diagnostic | otitis media | Main | ||
| F526.00 | Read | Acute left otitis media | diagnostic | otitis media | Main | ||
| F527.00 | Read | Acute right otitis media | diagnostic | otitis media | Main | ||
| f528.00 | Read | Acute bilateral otitis media | diagnostic | otitis media | Main | ||
| F528.00 | Read | Acute bilateral otitis media | diagnostic | otitis media | Main | ||
| F52z.00 | Read | Otitis media NOS | diagnostic | otitis media | Main | ||
| FyuP000 | Read | [X]Other acute nonsuppurative otitis media | diagnostic | otitis media | Main | ||
| FyuP100 | Read | [X]Other chronic nonsuppurative otitis media | diagnostic | otitis media | Main | ||
| FyuP200 | Read | [X]Other chronic suppurative otitis media | diagnostic | otitis media | Main | ||
| FyuP300 | Read | [X]Otitis media in bacterial diseases classified elsewhere | diagnostic | otitis media | Main | ||
| FyuP400 | Read | [X]Otitis media in viral diseases classified elsewhere | diagnostic | otitis media | Main | ||
| FyuP500 | Read | [X]Otitis media in other diseases classified elsewhere | diagnostic | otitis media | Main | ||
| SN30.11 | Read | Aero-otitis media | diagnostic | otitis media | Main | ||
| 3810 | OXMIS | OTITIS MEDIA ACUTE | diagnostic | otitis media | Main | ||
| 3810ML | OXMIS | OTITIS MEDIA ACUTE LEFT | diagnostic | otitis media | Main | ||
| 3810MR | OXMIS | OTITIS MEDIA ACUTE RIGHT | diagnostic | otitis media | Main | ||
| 3811A | OXMIS | OTITIS MEDIA CHRONIC | diagnostic | otitis media | Main | ||
| 3811AR | OXMIS | RECURRENT OTITIS MEDIA | diagnostic | otitis media | Main | ||
| 3811AT | OXMIS | OTITIS MEDIA CATARRHAL | diagnostic | otitis media | Main | ||
| 3811D | OXMIS | OTITIS MEDIA CHRONIC SUPPURATIVE | diagnostic | otitis media | Main | ||
| 3811E | OXMIS | OTITIS MEDIA BILATERAL SUPPURATIVE | diagnostic | otitis media | Main | ||
| 3811TR | OXMIS | SECRETORY OTITIS MEDIA | diagnostic | otitis media | Main | ||
| 3819 | OXMIS | OTITIS MEDIA | diagnostic | otitis media | Main | ||
| 3819E | OXMIS | OTITIS MEDIA BILATERAL | diagnostic | otitis media | Main | ||
| 3819MP | OXMIS | SUPPURATIVE OTITIS MEDIA | diagnostic | otitis media | Main | ||
| 3829 | OXMIS | OTITIS MEDIA WITH MASTOIDITIS | diagnostic | otitis media | Main |
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