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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: thyroid_function
85 codes in list
| Code | Coding system | Description | Entity type | List name | QOF | analysis | tsh |
|---|---|---|---|---|---|---|---|
| 442..00 | Read | Thyroid hormone tests | test | thyroid_function | 1 | Main | 0 |
| 4421.00 | Read | Thyroid hormone tests normal | test | thyroid_function | 1 | Main | 1 |
| 442..11 | Read | TRH level | test | thyroid_function | 1 | Main | 0 |
| 4421.11 | Read | Euthyroid | test | thyroid_function | 1 | Main | 0 |
| 442..12 | Read | TSH level | test | thyroid_function | 1 | Main | 1 |
| 442..13 | Read | Thyroid function tests | test | thyroid_function | 1 | Main | 1 |
| 442..14 | Read | Thyroxine binding globulin | test | thyroid_function | 1 | Main | 0 |
| 4422.00 | Read | Thyroid hormone tests high | test | thyroid_function | 1 | Main | 1 |
| 4423.00 | Read | Thyroid hormone tests low | test | thyroid_function | 1 | Main | 1 |
| 4424.00 | Read | Serum T3 level | test | thyroid_function | 1 | Main | 0 |
| 4424000 | Read | Serum T3 level normal | test | thyroid_function | 1 | Main | 0 |
| 4424100 | Read | Serum T3 level high | test | thyroid_function | 1 | Main | 0 |
| 4424200 | Read | Serum T3 level low | test | thyroid_function | 1 | Main | 0 |
| 4425.00 | Read | Free T3 level | test | thyroid_function | 1 | Main | 0 |
| 4426.00 | Read | Serum T4 level | test | thyroid_function | 1 | Main | 0 |
| 4426000 | Read | Serum T4 level normal | test | thyroid_function | 1 | Main | 0 |
| 4426100 | Read | Serum T4 level abnormal | test | thyroid_function | 1 | Main | 0 |
| 4427.00 | Read | Free T4 level | test | thyroid_function | 1 | Main | 0 |
| 4428.00 | Read | Free thyroxine index | test | thyroid_function | 1 | Main | 0 |
| 4429.00 | Read | Thyroxine binding globulin-TBG | test | thyroid_function | 1 | Main | 0 |
| 442a.00 | Read | Plasma total T4 level | test | thyroid_function | 1 | Main | 0 |
| 442A.00 | Read | TSH - thyroid stim. hormone | test | thyroid_function | 1 | Main | 1 |
| 442A000 | Read | Serum TSH level normal | test | thyroid_function | 1 | Main | 1 |
| 442A100 | Read | Serum TSH level abnormal | test | thyroid_function | 1 | Main | 1 |
| 442b.00 | Read | Serum total T4 level | test | thyroid_function | 1 | Main | 0 |
| 442B.00 | Read | TRH - thyroid release. hormone | test | thyroid_function | 1 | Main | 0 |
| 442c.00 | Read | Plasma free T4 level | test | thyroid_function | 1 | Main | 0 |
| 442C.00 | Read | Thyroid horm tests borderline | test | thyroid_function | 1 | Main | 0 |
| 442d.00 | Read | Serum thyroglobulin level | test | thyroid_function | 1 | Main | 0 |
| 442D.00 | Read | T3 uptake test | test | thyroid_function | 1 | Main | 0 |
| 442D000 | Read | T3 uptake test normal | test | thyroid_function | 1 | Main | 0 |
| 442D100 | Read | T3 uptake test abnormal | test | thyroid_function | 1 | Main | 0 |
| 442e.00 | Read | Blood spot TSH level | test | thyroid_function | 1 | Main | 1 |
| 442E.00 | Read | PBI - protein bound iodine estimation | test | thyroid_function | 1 | Main | 0 |
| 442f.00 | Read | Serum total T3 level | test | thyroid_function | 1 | Main | 0 |
| 442F.00 | Read | T3 suppression test | test | thyroid_function | 1 | Main | 0 |
| 442g.00 | Read | Serum thyroglobulin recovery level | test | thyroid_function | 1 | Main | 0 |
| 442G.00 | Read | Thyroid hormone tests abnormal | test | thyroid_function | 1 | Main | 1 |
| 442H.00 | Read | Thyroid function tests normal | test | thyroid_function | 1 | Main | 1 |
| 442I.00 | Read | Thyroid function tests abnormal | test | thyroid_function | 1 | Main | 1 |
| 442J.00 | Read | Thyroid function test | test | thyroid_function | 1 | Main | 1 |
| 442K.00 | Read | 30 minute plasma TSH level | test | thyroid_function | 1 | Main | 1 |
| 442L.00 | Read | 60 minute plasma TSH level | test | thyroid_function | 1 | Main | 1 |
| 442M.00 | Read | 90 minute plasma TSH level | test | thyroid_function | 1 | Main | 1 |
| 442N.00 | Read | 120 minute plasma TSH level | test | thyroid_function | 1 | Main | 1 |
| 442O.00 | Read | 150 minute plasma TSH level | test | thyroid_function | 1 | Main | 1 |
| 442P.00 | Read | 30 minute serum TSH level | test | thyroid_function | 1 | Main | 1 |
| 442Q.00 | Read | 60 minute serum TSH level | test | thyroid_function | 1 | Main | 1 |
| 442R.00 | Read | 90 minute serum TSH level | test | thyroid_function | 1 | Main | 1 |
| 442S.00 | Read | 120 minute serum TSH level | test | thyroid_function | 1 | Main | 1 |
| 442T.00 | Read | 150 minute serum TSH level | test | thyroid_function | 1 | Main | 1 |
| 442U.00 | Read | Serum free triiodothyronine level | test | thyroid_function | 1 | Main | 0 |
| 442V. | Read | test | thyroid_function | 1 | Main | 0 | |
| 442V.00 | Read | Serum free T4 level | test | thyroid_function | 1 | Main | 0 |
| 442W.00 | Read | Serum TSH level | test | thyroid_function | 1 | Main | 1 |
| 442X.00 | Read | Plasma TSH level | test | thyroid_function | 1 | Main | 1 |
| 442Y.00 | Read | Plasma free triiodothyronine level | test | thyroid_function | 1 | Main | 0 |
| 442Z.00 | Read | Thyroid hormone tests NOS | test | thyroid_function | 1 | Main | 0 |
| R145.00 | Read | [D]Thyroid function test abnormal | test | thyroid_function | 0 | Main | 1 |
| R145z00 | Read | [D]Thyroid function tests abnormal NOS | test | thyroid_function | 0 | Main | 1 |
| L 112MA | OXMIS | SERUM TSH | test | thyroid_function | 0 | Main | 1 |
| L 112MB | OXMIS | SERUM TSH NORMAL | test | thyroid_function | 0 | Main | 1 |
| L 112MC | OXMIS | SERUM TSH ABNORMAL | test | thyroid_function | 0 | Main | 1 |
| L 112N | OXMIS | TSH LEVEL | test | thyroid_function | 0 | Main | 1 |
| L 112NB | OXMIS | TSH LEVEL NORMAL | test | thyroid_function | 0 | Main | 1 |
| L 112NC | OXMIS | TSH LEVEL ABNORMAL | test | thyroid_function | 0 | Main | 1 |
| L4000T | OXMIS | SERUM THYROXINE LEVEL | test | thyroid_function | 0 | Main | 0 |
| L4000TE | OXMIS | THYROXINE ESTIMATION | test | thyroid_function | 0 | Main | 0 |
| L4021L | OXMIS | T4 LEVEL | test | thyroid_function | 0 | Main | 0 |
| L4021LA | OXMIS | T4 LEVEL ABNORMAL | test | thyroid_function | 0 | Main | 0 |
| L4021LN | OXMIS | T4 LEVEL NORMAL | test | thyroid_function | 0 | Main | 0 |
| L4021PA | OXMIS | T4 TOXICOSIS TEST ABNORMAL | test | thyroid_function | 0 | Main | 0 |
| L4021PN | OXMIS | T4 TOXICOSIS TEST NORMAL | test | thyroid_function | 0 | Main | 0 |
| L4021PV | OXMIS | T4 TOXICOSIS TEST | test | thyroid_function | 0 | Main | 0 |
| L4031 | OXMIS | T3 UPTAKE TEST | test | thyroid_function | 0 | Main | 0 |
| L4031AA | OXMIS | T3 UPTAKE TEST ABNORMAL | test | thyroid_function | 0 | Main | 0 |
| L4031AN | OXMIS | T3 UPTAKE TEST NORMAL | test | thyroid_function | 0 | Main | 0 |
| L4031HS | OXMIS | T3 SERUM LEVEL INCREASED | test | thyroid_function | 0 | Main | 0 |
| L4031LF | OXMIS | T3 FREE LEVEL | test | thyroid_function | 0 | Main | 0 |
| L4031LS | OXMIS | T3 SERUM LEVEL DECREASED | test | thyroid_function | 0 | Main | 0 |
| L4031NM | OXMIS | T3 LEVEL | test | thyroid_function | 0 | Main | 0 |
| L4033F | OXMIS | THYROID FUNCTION TEST | test | thyroid_function | 0 | Main | 1 |
| L4033FA | OXMIS | THYROID FUNCTION TEST ABNORMAL | test | thyroid_function | 0 | Main | 1 |
| L4033FN | OXMIS | THYROID FUNCTION TEST NORMAL | test | thyroid_function | 0 | Main | 1 |
| L4071 | OXMIS | T3 SUPPRESSION TEST | test | thyroid_function | 0 | Main | 0 |
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