| Title: |
Associations between exemption and survival outcomes in the UK's primary care pay-for-performance programme:a retrospective cohort study |
| Authors: |
Kontopantelis, Evangelos; Springate, David A.; Ashcroft, Darren M.; Valderas, Jose M.; van der Veer, Sabine N.; Reeves, David; Guthrie, Bruce; Doran, Tim |
| Source: |
Kontopantelis, E, Springate, D A, Ashcroft, D M, Valderas, J M, van der Veer, S N, Reeves, D, Guthrie, B & Doran, T 2016, 'Associations between exemption and survival outcomes in the UK's primary care pay-for-performance programme : a retrospective cohort study', BMJ Quality & Safety, vol. 25, no. 9, pp. 657-670. https://doi.org/10.1136/bmjqs-2015-004602 |
| Publication Year: |
2016 |
| Collection: |
Discovery - University of Dundee Online Publications |
| Description: |
OBJECTIVES: The UK's Quality and Outcomes Framework permits practices to exempt patients from financially-incentivised performance targets. To better understand the determinants and consequences of being exempted from the framework, we investigated the associations between exception reporting, patient characteristics and mortality. We also quantified the proportion of exempted patients that met quality targets for a tracer condition (diabetes). DESIGN: Retrospective longitudinal study, using individual patient data from the Clinical Practice Research Datalink. SETTING: 644 general practices, 2006/7 to 2011/12. PARTICIPANTS: Patients registered with study practices for at least one year over the study period, with at least one condition of interest (2 460 341 in total). MAIN OUTCOME MEASURES: Exception reporting rates by reason (clinical contraindication, patient dissent); all-cause mortality in year following exemption. Analyses with logistic and Cox proportional-hazards regressions, respectively. RESULTS: The odds of being exempted increased with age, deprivation and multimorbidity. Men were more likely to be exempted but this was largely attributable to higher prevalence of conditions with high exemption rates. Modest associations remained, with women more likely to be exempted due to clinical contraindication (OR 0.90, 99% CI 0.88 to 0.92) and men more likely to be exempted due to informed dissent (OR 1.08, 99% CI 1.06 to 1.10). More deprived areas (both for practice location and patient residence) were non-linearly associated with higher exception rates, after controlling for comorbidities and other covariates, with stronger associations for clinical contraindication. Compared with patients with a single condition, odds ratios for patients with two, three, or four or more conditions were respectively 4.28 (99% CI 4.18 to 4.38), 16.32 (99% CI 15.82 to 16.83) and 68.69 (99% CI 66.12 to 71.37) for contraindication, and 2.68 (99% CI 2.63 to 2.74), 4.02 (99% CI 3.91 to 4.13) and 5.17 (99% CI 5.00 to 5.35) for ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
application/pdf |
| Language: |
English |
| ISSN: |
2044-5415; 2044-5423 |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/26628553; info:eu-repo/semantics/altIdentifier/pissn/2044-5415; info:eu-repo/semantics/altIdentifier/eissn/2044-5423 |
| DOI: |
10.1136/bmjqs-2015-004602 |
| Availability: |
https://discovery.dundee.ac.uk/en/publications/950b35a5-c8e5-4cf9-bcf0-915213c40c73; https://doi.org/10.1136/bmjqs-2015-004602; https://discovery.dundee.ac.uk/ws/files/10385882/BMJ_Qual_Saf_2016_Kontopantelis_657_70.pdf |
| Rights: |
info:eu-repo/semantics/openAccess ; http://creativecommons.org/licenses/by-nc/4.0/ |
| Accession Number: |
edsbas.42B9FDAE |
| Database: |
BASE |