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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: Strong analgesics

988 codes in list

Code Coding system Description Entity type List name BNF_header BNF_code drug_substance_name
00012001 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00012002 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00181001 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00190009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00193010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00193011 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00234009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00259001 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00270001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00271001 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00286001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00310001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00321009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00322009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00322010 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00323009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00324009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00325009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00325010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00325011 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00326009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00327009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00328009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00329009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00330009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00331009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00332009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00333009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00334009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00335009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00336009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00337009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00353009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00353010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00353011 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00359011 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00361009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00363009 GPRD_product_code NA drug Strong analgesics NA 99000000 NA
00363010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00363011 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00364009 GPRD_product_code NA drug Strong analgesics NA 99000000 NA
00369001 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00370001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00370002 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00371009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00372009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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00487009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00487011 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00511009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00511010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00511011 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00535009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00535010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00536009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00536010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00539009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00539010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00539011 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00561001 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00561002 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00561003 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00569009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00569010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00603001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00603002 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00603003 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00604001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00604002 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00604003 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00641001 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00677001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00713001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00719009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00719010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00720009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00739001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00740001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00740002 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00754009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00755009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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00780009 GPRD_product_code NA drug Strong analgesics NA 99000000 NA
00851001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00851009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00851010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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00852010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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00874011 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00914002 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
00929001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00929002 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
00929003 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01054009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01054010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01124001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01124002 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01124003 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01125001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01147009 GPRD_product_code NA drug Strong analgesics NA 99000000 NA
01210001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01211001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01217001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01231009 GPRD_product_code NA drug Strong analgesics NA 99000000 NA
01262001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01262002 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01266009 GPRD_product_code NA drug Strong analgesics NA 99000000 NA
01279010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01279011 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01283010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01285009 GPRD_product_code NA drug Strong analgesics NA 99000000 NA
01351001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01351002 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01357001 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01366009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01366010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01366011 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01375009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01375010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01376009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01376010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01405009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01406009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01422009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01423009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01424009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01431009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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01520009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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01539009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01539010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01541001 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01541002 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01541003 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
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01581001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01643009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01643010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01650009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01657009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01668009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01668010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01668011 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01669009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01670009 GPRD_product_code NA drug Strong analgesics NA 99000000 NA
01678009 GPRD_product_code NA drug Strong analgesics NA 99000000 NA
01688001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01696009 GPRD_product_code NA drug Strong analgesics NA 99000000 NA
01786001 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01815009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01816009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01822009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01822010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01822011 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01823009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01825009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01862009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01905001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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01906001 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01906002 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01916001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01918001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01918002 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01923009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01940009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
01971009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01981001 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01981002 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
01981003 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
02015009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
02042009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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02080001 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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02128009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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02152009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
02152010 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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02304009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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02323009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
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02710007 GPRD_product_code NA drug Strong analgesics NA 0 NA
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02720007 GPRD_product_code NA drug Strong analgesics NA 0 NA
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02900009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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03255009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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03290007 GPRD_product_code NA drug Strong analgesics NA 0 NA
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03364009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
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03414007 GPRD_product_code NA drug Strong analgesics NA 0 NA
03415009 GPRD_product_code NA drug Strong analgesics NA 4070200 NA
03447001 GPRD_product_code NA drug Strong analgesics NA 15010403 NA
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03547009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
03569009 GPRD_product_code NA drug Strong analgesics NA 4070100 NA
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