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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: smoking_status
121 codes in list
| Code | Coding system | Description | Entity type | List name | status | cessation_advice | |
|---|---|---|---|---|---|---|---|
| 137..00 | Read | Tobacco consumption | observation | smoking_status | 1 | 0 | |
| 1371.00 | Read | Never smoked tobacco | observation | smoking_status | 1 | 0 | |
| 137..11 | Read | Smoker - amount smoked | observation | smoking_status | 1 | 0 | |
| 1371.11 | Read | Non-smoker | observation | smoking_status | 1 | 0 | |
| 1372.00 | Read | Trivial smoker - < 1 cig/day | observation | smoking_status | 1 | 0 | |
| 1372.11 | Read | Occasional smoker | observation | smoking_status | 1 | 0 | |
| 1373.00 | Read | Light smoker - 1-9 cigs/day | observation | smoking_status | 1 | 0 | |
| 1374.00 | Read | Moderate smoker - 10-19 cigs/d | observation | smoking_status | 1 | 0 | |
| 1375.00 | Read | Heavy smoker - 20-39 cigs/day | observation | smoking_status | 1 | 0 | |
| 1376.00 | Read | Very heavy smoker - 40+cigs/d | observation | smoking_status | 1 | 0 | |
| 1377.00 | Read | Ex-trivial smoker (<1/day) | observation | smoking_status | 1 | 0 | |
| 1378.00 | Read | Ex-light smoker (1-9/day) | observation | smoking_status | 1 | 0 | |
| 1379.00 | Read | Ex-moderate smoker (10-19/day) | observation | smoking_status | 1 | 0 | |
| 137a.00 | Read | Pipe tobacco consumption | observation | smoking_status | 1 | 0 | |
| 137A.00 | Read | Ex-heavy smoker (20-39/day) | observation | smoking_status | 1 | 0 | |
| 137b.00 | Read | Ready to stop smoking | observation | smoking_status | 1 | 0 | |
| 137B.00 | Read | Ex-very heavy smoker (40+/day) | observation | smoking_status | 1 | 0 | |
| 137c.00 | Read | Thinking about stopping smoking | observation | smoking_status | 1 | 0 | |
| 137C.00 | Read | Keeps trying to stop smoking | observation | smoking_status | 1 | 0 | |
| 137d.00 | Read | Not interested in stopping smoking | observation | smoking_status | 1 | 0 | |
| 137D.00 | Read | Admitted tobacco cons untrue ? | observation | smoking_status | 1 | 0 | |
| 137e.00 | Read | Smoking restarted | observation | smoking_status | 1 | 0 | |
| 137f.00 | Read | Reason for restarting smoking | observation | smoking_status | 1 | 0 | |
| 137F.00 | Read | Ex-smoker - amount unknown | observation | smoking_status | 1 | 0 | |
| 137g.00 | Read | Cigarette pack-years | observation | smoking_status | 1 | 0 | |
| 137G.00 | Read | Trying to give up smoking | observation | smoking_status | 1 | 0 | |
| 137h.00 | Read | Minutes from waking to first tobacco consumption | observation | smoking_status | 1 | 0 | |
| 137H.00 | Read | Pipe smoker | observation | smoking_status | 1 | 0 | |
| 137J.00 | Read | Cigar smoker | observation | smoking_status | 1 | 0 | |
| 137K.00 | Read | Stopped smoking | observation | smoking_status | 1 | 0 | |
| 137L.0 | Read | observation | smoking_status | 1 | 0 | ||
| 137L.00 | Read | Current non-smoker | observation | smoking_status | 1 | 0 | |
| 137M.00 | Read | Rolls own cigarettes | observation | smoking_status | 1 | 0 | |
| 137N.00 | Read | Ex pipe smoker | observation | smoking_status | 1 | 0 | |
| 137O.00 | Read | Ex cigar smoker | observation | smoking_status | 1 | 0 | |
| 137P.00 | Read | Cigarette smoker | observation | smoking_status | 1 | 0 | |
| 137P.11 | Read | Smoker | observation | smoking_status | 1 | 0 | |
| 137Q.00 | Read | Smoking started | observation | smoking_status | 1 | 0 | |
| 137Q.11 | Read | Smoking restarted | observation | smoking_status | 1 | 0 | |
| 137R.00 | Read | Current smoker | observation | smoking_status | 1 | 0 | |
| 137S.00 | Read | Ex smoker | observation | smoking_status | 1 | 0 | |
| 137T.00 | Read | Date ceased smoking | observation | smoking_status | 1 | 0 | |
| 137U.00 | Read | Not a passive smoker | observation | smoking_status | 1 | 0 | |
| 137V.00 | Read | Smoking reduced | observation | smoking_status | 1 | 0 | |
| 137X.00 | Read | Cigarette consumption | observation | smoking_status | 1 | 0 | |
| 137Y.00 | Read | Cigar consumption | observation | smoking_status | 1 | 0 | |
| 137Z.00 | Read | Tobacco consumption NOS | observation | smoking_status | 1 | 0 | |
| 13p..00 | Read | Smoking cessation milestones | observation | smoking_status | 0 | 1 | |
| 13p0.00 | Read | Negotiated date for cessation of smoking | observation | smoking_status | 0 | 1 | |
| 13p1.00 | Read | Smoking status at 4 weeks | observation | smoking_status | 0 | 1 | |
| 13p2.00 | Read | Smoking status between 4 and 52 weeks | observation | smoking_status | 0 | 1 | |
| 13p3.00 | Read | Smoking status at 52 weeks | observation | smoking_status | 0 | 1 | |
| 13p4.00 | Read | Smoking free weeks | observation | smoking_status | 0 | 1 | |
| 13p5.00 | Read | Smoking cessation programme start date | observation | smoking_status | 0 | 1 | |
| 6791.00 | Read | Health ed. - smoking | observation | smoking_status | 0 | 1 | |
| 67A3.00 | Read | Pregnancy smoking advice | observation | smoking_status | 0 | 1 | |
| 67H1.00 | Read | Lifestyle advice regarding smoking | observation | smoking_status | 0 | 1 | |
| 745H.00 | Read | Smoking cessation therapy | observation | smoking_status | 0 | 1 | |
| 745H000 | Read | Nicotine replacement therapy using nicotine patches | observation | smoking_status | 0 | 1 | |
| 745H100 | Read | Nicotine replacement therapy using nicotine gum | observation | smoking_status | 0 | 1 | |
| 745H200 | Read | Nicotine replacement therapy using nicotine inhalator | observation | smoking_status | 0 | 1 | |
| 745H300 | Read | Nicotine replacement therapy using nicotine lozenges | observation | smoking_status | 0 | 1 | |
| 8B2B.00 | Read | Nicotine replacement therapy | observation | smoking_status | 0 | 1 | |
| 8B3f.00 | Read | Nicotine replacement therapy provided free | observation | smoking_status | 0 | 1 | |
| 8B3Y.00 | Read | Over the counter nicotine replacement therapy | observation | smoking_status | 0 | 1 | |
| 8BP3.00 | Read | Nicotine replacement therapy provided by community pharmacis | observation | smoking_status | 0 | 1 | |
| 8CAg.00 | Read | Smoking cessation advice provided by community pharmacist | observation | smoking_status | 0 | 1 | |
| 8CAL.00 | Read | Smoking cessation advice | observation | smoking_status | 0 | 1 | |
| 8H7i.00 | Read | Referral to smoking cessation advisor | observation | smoking_status | 0 | 1 | |
| 8HTK.00 | Read | Referral to stop-smoking clinic | observation | smoking_status | 0 | 1 | |
| 9N2k.00 | Read | Seen by smoking cessation advisor | observation | smoking_status | 0 | 1 | |
| 9N4M.00 | Read | DNA - Did not attend smoking cessation clinic | observation | smoking_status | 0 | 1 | |
| 9OO..00 | Read | Anti-smoking monitoring admin. | observation | smoking_status | 0 | 2 | |
| 9OO1.00 | Read | Attends stop smoking monitor. | observation | smoking_status | 0 | 2 | |
| 9OO..11 | Read | Stop smoking clinic admin. | observation | smoking_status | 0 | 2 | |
| 9OO..12 | Read | Stop smoking monitoring admin. | observation | smoking_status | 0 | 2 | |
| 9OO2.00 | Read | Refuses stop smoking monitor | observation | smoking_status | 0 | 2 | |
| 9OO3.00 | Read | Stop smoking monitor default | observation | smoking_status | 0 | 2 | |
| 9OO4.00 | Read | Stop smoking monitor 1st lettr | observation | smoking_status | 0 | 2 | |
| 9OO5.00 | Read | Stop smoking monitor 2nd lettr | observation | smoking_status | 0 | 2 | |
| 9OO6.00 | Read | Stop smoking monitor 3rd lettr | observation | smoking_status | 0 | 2 | |
| 9OO7.00 | Read | Stop smoking monitor verb.inv. | observation | smoking_status | 0 | 2 | |
| 9OO8.00 | Read | Stop smoking monitor phone inv | observation | smoking_status | 0 | 2 | |
| 9OO9.00 | Read | Stop smoking monitoring delete | observation | smoking_status | 0 | 2 | |
| 9OOA.00 | Read | Stop smoking monitor.chck done | observation | smoking_status | 0 | 2 | |
| ZG23300 | Read | Advice on smoking | observation | smoking_status | 0 | 1 | |
| ZRaM.00 | Read | Motives for smoking scale | observation | smoking_status | 0 | 1 | |
| ZRh4.00 | Read | Reasons for smoking scale | observation | smoking_status | 0 | 1 | |
| ZRh4.11 | Read | RFS - Reasons for smoking scale | observation | smoking_status | 0 | 1 | |
| L5091S | OXMIS | SMOKING STARTED | observation | smoking_status | 0 | 1 | |
| T509 | OXMIS | SMOKER | observation | smoking_status | 1 | 0 | |
| T5090OR | OXMIS | SMOKER OWN ROLLED | observation | smoking_status | 1 | 0 | |
| T5090XC | OXMIS | SMOKER CIGARETTES | observation | smoking_status | 1 | 0 | |
| T5091 | OXMIS | STOPPED SMOKING | observation | smoking_status | 1 | 0 | |
| T5091ES | OXMIS | FORMER SMOKER | observation | smoking_status | 1 | 0 | |
| T5091HS | OXMIS | EX HEAVY SMOKER | observation | smoking_status | 1 | 0 | |
| T5092 | OXMIS | SMOKING ADVISED TO STOP | observation | smoking_status | 0 | 1 | |
| T5092S | OXMIS | SMOKING WISHES TO STOP | observation | smoking_status | 1 | 0 | |
| T5092SA | OXMIS | SMOKING WANTS TO STOP | observation | smoking_status | 1 | 0 | |
| T5093 | OXMIS | SMOKER NON | observation | smoking_status | 1 | 0 | |
| T5093N | OXMIS | SMOKED NEVER | observation | smoking_status | 1 | 0 | |
| T509 SR | OXMIS | SMOKING RESTARTED | observation | smoking_status | 1 | 0 | |
| T510 | OXMIS | EXCESSIVE SMOKING | observation | smoking_status | 1 | 0 | |
| T510 HS | OXMIS | HEAVY SMOKER (20-PLUS PER DAY) | observation | smoking_status | 1 | 0 | |
| T510 SE | OXMIS | SMOKING EXCESSIVE | observation | smoking_status | 1 | 0 | |
| T510 SH | OXMIS | SMOKER HEAVY (20-PLUS PER DAY) | observation | smoking_status | 1 | 0 | |
| T511 | OXMIS | SMOKER MODERATE (LESS THAN 20 PER DAY) | observation | smoking_status | 1 | 0 | |
| T5112 | OXMIS | SMOKER (20 PER DAY) | observation | smoking_status | 1 | 0 | |
| T5113 | OXMIS | SMOKER (15 PER DAY) | observation | smoking_status | 1 | 0 | |
| T5114 | OXMIS | SMOKER (10 PER DAY) | observation | smoking_status | 1 | 0 | |
| T5115 | OXMIS | SMOKER (LESS THAN 10 PER DAY) | observation | smoking_status | 1 | 0 | |
| T5115M | OXMIS | SMOKER MILD (5 OR LESS PER DAY) | observation | smoking_status | 1 | 0 | |
| T5116 | OXMIS | SMOKER(OCCASIONAL) | observation | smoking_status | 1 | 0 | |
| T5117 | OXMIS | SMOKER (30 PER DAY) | observation | smoking_status | 1 | 0 | |
| T512 | OXMIS | SMOKER PIPE | observation | smoking_status | 1 | 0 | |
| T513 | OXMIS | SMOKER CIGARS | observation | smoking_status | 1 | 0 | |
| Y0601JJ | OXMIS | CLINIC ANTI-SMOKING ATTENDANCE | observation | smoking_status | 0 | 1 | |
| Y0601KA | OXMIS | SMOKING CLINIC ATTENDANCE | observation | smoking_status | 0 | 1 | |
| Y060 J1 | OXMIS | STOP SMOKING GROUP | observation | smoking_status | 0 | 1 | |
| Y060 JJ | OXMIS | CLINIC ANTI-SMOKING | observation | smoking_status | 0 | 1 | |
| Y060 KA | OXMIS | SMOKING CLINIC | observation | smoking_status | 0 | 1 |
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