Exempting dissenting patients from pay for performance schemes: retrospective analysis of exception reporting in the UK Quality and Outcomes Framework

Tim Doran, Evangelos Kontopantelis, Catherine Fullwood, Helen Lester, Jose Valderas, Stephen Campbell

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective To examine the reasons why practices exempt patients from the UK Quality and Outcomes Framework pay for performance scheme (exception reporting) and to identify the characteristics of general practices associated with informed dissent.

Design Retrospective analysis.

Setting Data for 2008-9 extracted from the clinical computing systems of general practices in England.

Participants 8229 English family practices.

Main outcome measures Rates of exception reporting for 37 clinical quality indicators, associations of patient and general practice factors with exception rates, and financial gain for practices relating to their use of exception reporting.

Results The median rate of exception reporting was 2.7% (interquartile range 1.9-3.9%) overall and 0.44% (0.14-1.1%) for informed dissent, but variation in rates was wide between practices and across indicators. Common reasons for exception reporting were logistical (40.6% of exceptions), clinical contraindication (18.7%), and patient informed dissent (30.1%). Higher rates of informed dissent were associated with: higher numbers of registered patients, higher levels of local area deprivation, and failure of the practice to secure maximum remuneration in the previous year. Exception reporting increased the cost of the scheme by 30 pound 844 500 ((sic)36 877 700; $49 053 200) (0.58 pound per patient), with two indicators accounting for a quarter of this additional cost.

Conclusions The provision to exception report enables practices to exempt dissenting patients without being financially penalised. Relatively few patients were excluded for informed dissent, however, suggesting that the incentivised activities were broadly acceptable to patients
Original languageEnglish
Article numbere2405
Pages (from-to)1-11
Number of pages11
JournalBMJ
Volume344
DOIs
Publication statusPublished - 2012
Externally publishedYes

Fingerprint

Incentive Reimbursement
Dissent and Disputes
General Practice
Remuneration
Costs and Cost Analysis
Family Practice
England
Outcome Assessment (Health Care)

Cite this

Doran, Tim ; Kontopantelis, Evangelos ; Fullwood, Catherine ; Lester, Helen ; Valderas, Jose ; Campbell, Stephen. / Exempting dissenting patients from pay for performance schemes: retrospective analysis of exception reporting in the UK Quality and Outcomes Framework. In: BMJ. 2012 ; Vol. 344. pp. 1-11.
@article{5255007bdf284e9d9c10cae1d2cbb817,
title = "Exempting dissenting patients from pay for performance schemes: retrospective analysis of exception reporting in the UK Quality and Outcomes Framework",
abstract = "Objective To examine the reasons why practices exempt patients from the UK Quality and Outcomes Framework pay for performance scheme (exception reporting) and to identify the characteristics of general practices associated with informed dissent. Design Retrospective analysis. Setting Data for 2008-9 extracted from the clinical computing systems of general practices in England. Participants 8229 English family practices. Main outcome measures Rates of exception reporting for 37 clinical quality indicators, associations of patient and general practice factors with exception rates, and financial gain for practices relating to their use of exception reporting. Results The median rate of exception reporting was 2.7{\%} (interquartile range 1.9-3.9{\%}) overall and 0.44{\%} (0.14-1.1{\%}) for informed dissent, but variation in rates was wide between practices and across indicators. Common reasons for exception reporting were logistical (40.6{\%} of exceptions), clinical contraindication (18.7{\%}), and patient informed dissent (30.1{\%}). Higher rates of informed dissent were associated with: higher numbers of registered patients, higher levels of local area deprivation, and failure of the practice to secure maximum remuneration in the previous year. Exception reporting increased the cost of the scheme by 30 pound 844 500 ((sic)36 877 700; $49 053 200) (0.58 pound per patient), with two indicators accounting for a quarter of this additional cost.Conclusions The provision to exception report enables practices to exempt dissenting patients without being financially penalised. Relatively few patients were excluded for informed dissent, however, suggesting that the incentivised activities were broadly acceptable to patients",
author = "Tim Doran and Evangelos Kontopantelis and Catherine Fullwood and Helen Lester and Jose Valderas and Stephen Campbell",
year = "2012",
doi = "10.1136/bmj.e2405",
language = "English",
volume = "344",
pages = "1--11",
journal = "British Medical Journal",
issn = "0959-535X",
publisher = "BMJ Publishing Group",

}

Exempting dissenting patients from pay for performance schemes: retrospective analysis of exception reporting in the UK Quality and Outcomes Framework. / Doran, Tim; Kontopantelis, Evangelos; Fullwood, Catherine; Lester, Helen; Valderas, Jose; Campbell, Stephen.

In: BMJ, Vol. 344, e2405, 2012, p. 1-11.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Exempting dissenting patients from pay for performance schemes: retrospective analysis of exception reporting in the UK Quality and Outcomes Framework

AU - Doran, Tim

AU - Kontopantelis, Evangelos

AU - Fullwood, Catherine

AU - Lester, Helen

AU - Valderas, Jose

AU - Campbell, Stephen

PY - 2012

Y1 - 2012

N2 - Objective To examine the reasons why practices exempt patients from the UK Quality and Outcomes Framework pay for performance scheme (exception reporting) and to identify the characteristics of general practices associated with informed dissent. Design Retrospective analysis. Setting Data for 2008-9 extracted from the clinical computing systems of general practices in England. Participants 8229 English family practices. Main outcome measures Rates of exception reporting for 37 clinical quality indicators, associations of patient and general practice factors with exception rates, and financial gain for practices relating to their use of exception reporting. Results The median rate of exception reporting was 2.7% (interquartile range 1.9-3.9%) overall and 0.44% (0.14-1.1%) for informed dissent, but variation in rates was wide between practices and across indicators. Common reasons for exception reporting were logistical (40.6% of exceptions), clinical contraindication (18.7%), and patient informed dissent (30.1%). Higher rates of informed dissent were associated with: higher numbers of registered patients, higher levels of local area deprivation, and failure of the practice to secure maximum remuneration in the previous year. Exception reporting increased the cost of the scheme by 30 pound 844 500 ((sic)36 877 700; $49 053 200) (0.58 pound per patient), with two indicators accounting for a quarter of this additional cost.Conclusions The provision to exception report enables practices to exempt dissenting patients without being financially penalised. Relatively few patients were excluded for informed dissent, however, suggesting that the incentivised activities were broadly acceptable to patients

AB - Objective To examine the reasons why practices exempt patients from the UK Quality and Outcomes Framework pay for performance scheme (exception reporting) and to identify the characteristics of general practices associated with informed dissent. Design Retrospective analysis. Setting Data for 2008-9 extracted from the clinical computing systems of general practices in England. Participants 8229 English family practices. Main outcome measures Rates of exception reporting for 37 clinical quality indicators, associations of patient and general practice factors with exception rates, and financial gain for practices relating to their use of exception reporting. Results The median rate of exception reporting was 2.7% (interquartile range 1.9-3.9%) overall and 0.44% (0.14-1.1%) for informed dissent, but variation in rates was wide between practices and across indicators. Common reasons for exception reporting were logistical (40.6% of exceptions), clinical contraindication (18.7%), and patient informed dissent (30.1%). Higher rates of informed dissent were associated with: higher numbers of registered patients, higher levels of local area deprivation, and failure of the practice to secure maximum remuneration in the previous year. Exception reporting increased the cost of the scheme by 30 pound 844 500 ((sic)36 877 700; $49 053 200) (0.58 pound per patient), with two indicators accounting for a quarter of this additional cost.Conclusions The provision to exception report enables practices to exempt dissenting patients without being financially penalised. Relatively few patients were excluded for informed dissent, however, suggesting that the incentivised activities were broadly acceptable to patients

U2 - 10.1136/bmj.e2405

DO - 10.1136/bmj.e2405

M3 - Article

VL - 344

SP - 1

EP - 11

JO - British Medical Journal

JF - British Medical Journal

SN - 0959-535X

M1 - e2405

ER -