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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: stroke
105 codes in list
| Code | Coding system | Description | Entity type | List name | QOF | analysis | |
|---|---|---|---|---|---|---|---|
| 14A7.00 | Read | H/O: CVA/stroke | diagnostic | stroke | 0 | Sensitivity | |
| 14A7.12 | Read | H/O: stroke | diagnostic | stroke | 0 | Sensitivity | |
| 14AB.00 | Read | H/O: TIA | diagnostic | stroke | 0 | Sensitivity | |
| 14AK.00 | Read | H/O: Stroke in last year | diagnostic | stroke | 0 | Sensitivity | |
| 662e.00 | Read | Stroke/CVA annual review | diagnostic | stroke | 0 | Sensitivity | |
| 662M.00 | Read | Stroke monitoring | diagnostic | stroke | 0 | Sensitivity | |
| 662o.00 | Read | Haemorrhagic stroke monitoring | diagnostic | stroke | 0 | Sensitivity | |
| 7P24200 | Read | Delivery of rehabilitation for stroke | diagnostic | stroke | 0 | Sensitivity | |
| 8HBJ.00 | Read | Stroke / transient ischaemic attack referral | diagnostic | stroke | 0 | Sensitivity | |
| 8HHM.00 | Read | Ref to multidisciplinary stroke function improvement service | diagnostic | stroke | 0 | Sensitivity | |
| 8HTQ.00 | Read | Referral to stroke clinic | diagnostic | stroke | 0 | Sensitivity | |
| 9N0p.00 | Read | Seen in stroke clinic | diagnostic | stroke | 0 | Sensitivity | |
| F423600 | Read | Amaurosis fugax | diagnostic | stroke | 1 | Sensitivity | |
| G61..00 | Read | Intracerebral haemorrhage | diagnostic | stroke | 1 | Main | |
| G610.00 | Read | Cortical haemorrhage | diagnostic | stroke | 1 | Main | |
| G611.00 | Read | Internal capsule haemorrhage | diagnostic | stroke | 1 | Main | |
| G61..11 | Read | CVA - cerebrovascular accid due to intracerebral haemorrhage | diagnostic | stroke | 1 | Main | |
| G61..12 | Read | Stroke due to intracerebral haemorrhage | diagnostic | stroke | 1 | Main | |
| G612.00 | Read | Basal nucleus haemorrhage | diagnostic | stroke | 1 | Main | |
| G613.00 | Read | Cerebellar haemorrhage | diagnostic | stroke | 1 | Main | |
| G614.00 | Read | Pontine haemorrhage | diagnostic | stroke | 1 | Main | |
| G615.00 | Read | Bulbar haemorrhage | diagnostic | stroke | 1 | Main | |
| G616.00 | Read | External capsule haemorrhage | diagnostic | stroke | 1 | Main | |
| G618.00 | Read | Intracerebral haemorrhage; multiple localized | diagnostic | stroke | 1 | Main | |
| G61X.00 | Read | Intracerebral haemorrhage in hemisphere; unspecified | diagnostic | stroke | 1 | Main | |
| G61X000 | Read | Left sided intracerebral haemorrhage; unspecified | diagnostic | stroke | 1 | Main | |
| G61X100 | Read | Right sided intracerebral haemorrhage; unspecified | diagnostic | stroke | 1 | Main | |
| G61z.00 | Read | Intracerebral haemorrhage NOS | diagnostic | stroke | 1 | Main | |
| G63y000 | Read | Cerebral infarct due to thrombosis of precerebral arteries | diagnostic | stroke | 1 | Main | |
| G63y100 | Read | Cerebral infarction due to embolism of precerebral arteries | diagnostic | stroke | 1 | Main | |
| G64..00 | Read | Cerebral arterial occlusion | diagnostic | stroke | 1 | Main | |
| G640.00 | Read | Cerebral thrombosis | diagnostic | stroke | 1 | Main | |
| G640000 | Read | Cerebral infarction due to thrombosis of cerebral arteries | diagnostic | stroke | 1 | Main | |
| G641.00 | Read | Cerebral embolism | diagnostic | stroke | 1 | Main | |
| G641000 | Read | Cerebral infarction due to embolism of cerebral arteries | diagnostic | stroke | 1 | Main | |
| G64..11 | Read | CVA - cerebral artery occlusion | diagnostic | stroke | 1 | Main | |
| G641.11 | Read | Cerebral embolus | diagnostic | stroke | 1 | Main | |
| G64..12 | Read | Infarction - cerebral | diagnostic | stroke | 1 | Main | |
| G64..13 | Read | Stroke due to cerebral arterial occlusion | diagnostic | stroke | 1 | Main | |
| G64z.00 | Read | Cerebral infarction NOS | diagnostic | stroke | 1 | Main | |
| G64z000 | Read | Brainstem infarction | diagnostic | stroke | 1 | Main | |
| G64z100 | Read | Wallenberg syndrome | diagnostic | stroke | 1 | Main | |
| G64z.11 | Read | Brainstem infarction NOS | diagnostic | stroke | 1 | Main | |
| G64z111 | Read | Lateral medullary syndrome | diagnostic | stroke | 1 | Main | |
| G64z.12 | Read | Cerebellar infarction | diagnostic | stroke | 1 | Main | |
| G64z200 | Read | Left sided cerebral infarction | diagnostic | stroke | 1 | Main | |
| G64z300 | Read | Right sided cerebral infarction | diagnostic | stroke | 1 | Main | |
| G64z400 | Read | Infarction of basal ganglia | diagnostic | stroke | 1 | Main | |
| G65..00 | Read | Transient cerebral ischaemia | diagnostic | stroke | 1 | Main | |
| G650.00 | Read | Basilar artery syndrome | diagnostic | stroke | 1 | Main | |
| G650.11 | Read | Insufficiency - basilar artery | diagnostic | stroke | 1 | Main | |
| G651.00 | Read | Vertebral artery syndrome | diagnostic | stroke | 1 | Main | |
| G651000 | Read | Vertebro-basilar artery syndrome | diagnostic | stroke | 1 | Main | |
| G65..11 | Read | Drop attack | diagnostic | stroke | 1 | Main | |
| G65..12 | Read | Transient ischaemic attack | diagnostic | stroke | 1 | Main | |
| G65..13 | Read | Vertebro-basilar insufficiency | diagnostic | stroke | 1 | Main | |
| G652.00 | Read | Subclavian steal syndrome | diagnostic | stroke | 1 | Main | |
| G653.00 | Read | Carotid artery syndrome hemispheric | diagnostic | stroke | 1 | Main | |
| G654.00 | Read | Multiple and bilateral precerebral artery syndromes | diagnostic | stroke | 1 | Main | |
| G656.00 | Read | Vertebrobasilar insufficiency | diagnostic | stroke | 1 | Main | |
| G65y.00 | Read | Other transient cerebral ischaemia | diagnostic | stroke | 1 | Main | |
| G65z.00 | Read | Transient cerebral ischaemia NOS | diagnostic | stroke | 1 | Main | |
| G65z000 | Read | Impending cerebral ischaemia | diagnostic | stroke | 1 | Main | |
| G65z100 | Read | Intermittent cerebral ischaemia | diagnostic | stroke | 1 | Main | |
| G65zz00 | Read | Transient cerebral ischaemia NOS | diagnostic | stroke | 1 | Main | |
| G66..00 | Read | Stroke and cerebrovascular accident unspecified | diagnostic | stroke | 1 | Main | |
| G660.00 | Read | Middle cerebral artery syndrome | diagnostic | stroke | 1 | Main | |
| G661.00 | Read | Anterior cerebral artery syndrome | diagnostic | stroke | 1 | Main | |
| G66..11 | Read | CVA unspecified | diagnostic | stroke | 1 | Main | |
| G66..12 | Read | Stroke unspecified | diagnostic | stroke | 1 | Main | |
| G66..13 | Read | CVA - Cerebrovascular accident unspecified | diagnostic | stroke | 1 | Main | |
| G662.00 | Read | Posterior cerebral artery syndrome | diagnostic | stroke | 1 | Main | |
| G663.00 | Read | Brain stem stroke syndrome | diagnostic | stroke | 1 | Main | |
| G664.00 | Read | Cerebellar stroke syndrome | diagnostic | stroke | 1 | Main | |
| G665.00 | Read | Pure motor lacunar syndrome | diagnostic | stroke | 1 | Main | |
| G666.00 | Read | Pure sensory lacunar syndrome | diagnostic | stroke | 1 | Main | |
| G667.00 | Read | Left sided CVA | diagnostic | stroke | 1 | Main | |
| G668.00 | Read | Right sided CVA | diagnostic | stroke | 1 | Main | |
| G68X.00 | Read | Sequelae of stroke;not specfd as h'morrhage or infarction | diagnostic | stroke | 0 | Sensitivity | |
| G6W..00 | Read | Cereb infarct due unsp occlus/stenos precerebr arteries | diagnostic | stroke | 1 | Main | |
| G6X..00 | Read | Cerebrl infarctn due/unspcf occlusn or sten/cerebrl artrs | diagnostic | stroke | 1 | Main | |
| Gyu6200 | Read | [X]Other intracerebral haemorrhage | diagnostic | stroke | 1 | Main | |
| Gyu6300 | Read | [X]Cerebrl infarctn due/unspcf occlusn or sten/cerebrl artrs | diagnostic | stroke | 1 | Main | |
| Gyu6400 | Read | [X]Other cerebral infarction | diagnostic | stroke | 1 | Main | |
| Gyu6500 | Read | [X]Occlusion and stenosis of other precerebral arteries | diagnostic | stroke | 1 | Main | |
| Gyu6600 | Read | [X]Occlusion and stenosis of other cerebral arteries | diagnostic | stroke | 1 | Main | |
| Gyu6C00 | Read | [X]Sequelae of stroke;not specfd as h'morrhage or infarction | diagnostic | stroke | 0 | Sensitivity | |
| Gyu6D00 | Read | [X]Sequelae/other + unspecified cerebrovascular diseases | diagnostic | stroke | 0 | Sensitivity | |
| Gyu6F00 | Read | [X]Intracerebral haemorrhage in hemisphere; unspecified | diagnostic | stroke | 1 | Sensitivity | |
| Gyu6G00 | Read | [X]Cereb infarct due unsp occlus/stenos precerebr arteries | diagnostic | stroke | 1 | Main | |
| L440.11 | Read | CVA - cerebrovascular accident in the puerperium | diagnostic | stroke | 0 | Main | |
| L440.12 | Read | Stroke in the puerperium | diagnostic | stroke | 0 | Main | |
| ZV12511 | Read | [V]Personal history of stroke | diagnostic | stroke | 0 | Sensitivity | |
| ZV12512 | Read | [V]Personal history of cerebrovascular accident (CVA) | diagnostic | stroke | 0 | Sensitivity | |
| 4350AT | OXMIS | TRANSIENT ISCHAEMIC ATTACKS WITH HYPERTE | diagnostic | stroke | 0 | Main | |
| 4359AT | OXMIS | TRANSIENT ISCHAEMIC ATTACKS | diagnostic | stroke | 0 | Main | |
| 4360A | OXMIS | CEREBROVASCULAR ACCIDENT WITH HYPERTENSI | diagnostic | stroke | 0 | Main | |
| 4360B | OXMIS | STROKE WITH HYPERTENSION | diagnostic | stroke | 0 | Main | |
| 4369A | OXMIS | CVA (CEREBROVASCULAR ACCIDENT) | diagnostic | stroke | 0 | Main | |
| 4369AL | OXMIS | CEREBROVASCULAR ACCIDENT LEFT | diagnostic | stroke | 0 | Main | |
| 4369AR | OXMIS | CEREBROVASCULAR ACCIDENT RIGHT | diagnostic | stroke | 0 | Main | |
| 4369B | OXMIS | STROKE | diagnostic | stroke | 0 | Main | |
| 4369BN | OXMIS | SYNDROME STROKE | diagnostic | stroke | 0 | Main | |
| 4389PN | OXMIS | SYNDROME POSTSTROKE | diagnostic | stroke | 0 | Sensitivity | |
| 4389PP | OXMIS | POSTSTROKE PARALYSIS | diagnostic | stroke | 0 | Sensitivity |
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