Related Experiment Video
Updated: May 3, 2026
The Participant-Reported Implementation Update and Score PRIUS: A Novel Method for Capturing Implementation-Related Data Over Time
Published on: February 19, 2021
Withdrawing performance indicators: retrospective analysis of general practice performance under UK Quality and
Evangelos Kontopantelis1, David Springate, David Reeves
1NIHR School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester M13 9PL, UK.
Objectives:
To investigate the effect of withdrawing incentives on recorded quality of care, in the context of the UK Quality and Outcomes Framework pay for performance scheme.
Design:
Retrospective longitudinal study.
Setting:
Data for 644 general practices, from 2004/05 to 2011/12, extracted from the Clinical Practice Research Datalink.
Participants:
All patients registered with any of the practices over the study period-13,772,992 in total.
Intervention:
Removal of financial incentives for aspects of care for patients with asthma, coronary heart disease, diabetes, stroke, and psychosis.
Main Outcome Measures:
Performance on eight clinical quality indicators withdrawn from a national incentive scheme: influenza immunisation (asthma) and lithium treatment monitoring (psychosis), removed in April 2006; blood pressure monitoring (coronary heart disease, diabetes, stroke), cholesterol concentration monitoring (coronary heart disease, diabetes), and blood glucose monitoring (diabetes), removed in April 2011. Multilevel mixed effects multiple linear regression models were used to quantify the effect of incentive withdrawal.
Results:
Mean levels of performance were generally stable after the removal of the incentives, in both the short and long term. For the two indicators removed in April 2006, levels in 2011/12 were very close to 2005/06 levels, although a small but statistically significant drop was estimated for influenza immunisation. For five of the six indicators withdrawn from April 2011, no significant effect on performance was seen following removal and differences between predicted and observed scores were small. Performance on related outcome indicators retained in the scheme (such as blood pressure control) was generally unaffected.
Conclusions:
Following the removal of incentives, levels of performance across a range of clinical activities generally remained stable. This indicates that health benefits from incentive schemes can potentially be increased by periodically replacing existing indicators with new indicators relating to alternative aspects of care. However, all aspects of care investigated remained indirectly or partly incentivised in other indicators, and further work is needed to assess the generalisability of the findings when incentives are fully withdrawn.
Related Concept Videos
01:15Nursing Evaluation
01:11Guidelines for Writing Outcome
Patient outcomes reflect the patient's response to the goal rather than what the nurse aims to achieve. Terminology should be observable and measurable to avoid the reader's interpretation. The desired outcome should be realistic and achievable in the designated care timeframe. Expected outcomes should align with adjunctive therapies. The outcome should enhance care...
01:30Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:11Purpose of Health Records I
Here's a breakdown of how health records serve these purposes:
01:21Methods of Documentation III: PIE
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...