SAPC 2012 - exception reporting
20
Background Methods Results Summary Exempting dissenting patients from pay for performance schemes retrospective analysis of exception reporting in the UK Quality and Outcomes Framework Tim Doran 1 Evan Kontopantelis 1 Catherine Fullwood 1 Helen Lester 2 Jose Valderas 3 Stephen Campbell 1 1 Centre for Primary Care, Institute of Population Health Faculty of Medicine, University of Manchester 2 School of Health and Population Sciences, University of Birmingham 3 Department of Primary Care Health Sciences, University of Oxford RSS Annual Conference Kontopantelis, Reeves Exception reporting under QOF
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Exempting dissenting patients from pay for performance schemes: retrospective analysis of exception reporting in the UK Quality and Outcomes Framework
Transcript of SAPC 2012 - exception reporting
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[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
Label Two
Label Three
Label Four
[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
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Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Exempting dissenting patients from pay forperformance schemes
retrospective analysis of exception reporting in the UK Qualityand Outcomes Framework
Tim Doran1 Evan Kontopantelis1 Catherine Fullwood1
Helen Lester2 Jose Valderas3 Stephen Campbell1
1Centre for Primary Care, Institute of Population HealthFaculty of Medicine, University of Manchester
2School of Health and Population Sciences, University of Birmingham
3Department of Primary Care Health Sciences, University of Oxford
RSS Annual ConferenceGlasgow, 3 Oct 2012
Kontopantelis, Reeves Exception reporting under QOF
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[Poster title]
ABSTRACT TITLE: [Add text here.]
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OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
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[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
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METHODS
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Outline
1 Background
2 Methods
3 Results
4 Summary
Kontopantelis, Reeves Exception reporting under QOF
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[Poster title]
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OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
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[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
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RESULTS
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CONCLUSIONS
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RESULTS
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Improving quality of carea (very) juicy carrot...
A P4P program kicked off in April 2004 with theintroduction of a new GP contract
General practices are rewarded for achieving a set ofquality targets for patients with chronic conditionsThe aim was to increase overall quality of care and toreduce variation in quality between practices
The incentive scheme for payment of GPs was namedQuality and Outcomes Framework (QOF)Initial investment estimated at £1.8 bn for 3 years(increasing GP income by up to 25%)QOF is reviewed at least every two years
Kontopantelis, Reeves Exception reporting under QOF
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[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
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METHODS
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RESULTS
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Quality and Outcomes Frameworkdetails for years 1 (2004/5) and 5 (2008/9)
Domains and indicators in year 1 (year 5):Clinical care for 10 (19) chronic diseases, with 76 (80)indicatorsOrganisation of care, with 56 (36) indicatorsAdditional services, with 10 (8) indicatorsPatient experience, with 4 (5) indicators
Implemented simultaneously in all practices (a controlgroup was out of the question)Practices are allowed to exclude patients from theindicators and the payment calculationsInto the 9th year now (01Mar12/31Apr13); cost for the first8 years was well above the estimate at ≈£8 bn
Kontopantelis, Reeves Exception reporting under QOF
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RESULTS: [Add text here.]
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Label One
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[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Some of the indicators for diabetic patientsPercentage of diabetics...
with a record of HbA1c in previous 15 months (3p)in whom last HbA1c is ≤7.4 in previous 15m (16p)who have a record of BP in the past 15m (3p)in whom the last BP is ≤145/85 (17p)with a rec of serum creatinine testing in previous 15m (3p)who have a record of total cholesterol in previous 15m (3p)whose last measured total cholesterol in previous 15m is≤5mmol/l (6p)who have had influenza immunisation in the preceding1Sep-31Mar (3p)
Kontopantelis, Reeves Exception reporting under QOF
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[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
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[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Exception reporting
For each indicator practices are permitted to removeinappropriate patients from achievement calculationsThe process is known as ‘exception reporting’ (ER) andreasons are:
logisticalclinical - contraindication or intoleranceclinical - patient unsuitableinformed dissent
In place to protect patients from coercion or refusal of carePrincipal drawback is that it allows practices to receivemaximum remuneration without necessarily providing therequired care for all eligible patients
Kontopantelis, Reeves Exception reporting under QOF
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[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
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[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Exception reporting reasons
LogisticalPatient has recently received a diagnosis or recentlyregistered with the practiceA specified investigative service is unavailable to thepractice
Clinical - contraindication or intolerancePatient has had an allergic or other adverse reaction to aspecified drug or has another contraindication to the drugPatient has not tolerated the drugPatient is taking the maximal tolerated dose of a drug, butthe levels remain suboptimal
Kontopantelis, Reeves Exception reporting under QOF
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[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
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[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
[Add title, if necessary.]
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RESULTS
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CONCLUSIONS
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Exception reporting reasons
Clinical - patient unsuitableThe indicator is judged inappropriate for the patientbecause of particular circumstances, such as terminalillness or extreme frailtyPatient has a supervening condition that makes thespecified treatment clinically inappropriatePatient has received at least three invitations for a reviewduring the preceding 12 months but has not attended
Informed dissentPatient refuses to be reviewedPatient does not agree to a specific investigation ortreatment
Not all reasons are available for every indicator e.g. nocontraindication option for measurement indicators
Kontopantelis, Reeves Exception reporting under QOF
Heal
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cien
ces P
rimar
y Ca
re R
esea
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Grou
p
[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
Label Two
Label Three
Label Four
[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
[Add title, if necessary.]
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
[Add title, if necessary.]
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BackgroundMethodsResults
Summary
The question
To examine the reasons why practices exempt patientsfrom the UK Quality and Outcomes FrameworkTo identify the characteristics of general practicesassociated with informed dissent
Kontopantelis, Reeves Exception reporting under QOF
Heal
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cien
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re R
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Grou
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[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
Label Two
Label Three
Label Four
[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
[Add title, if necessary.]
[Add key point.] [Add description of key point.]
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[Add key point.] [Add description of key point.]
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RESULTS
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CONCLUSIONS
[Add text as bulleted list or a paragraph.] [Add key point.]
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RESULTS
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Data
In 2008/9 (year 5), 62 clinical activity indicators across 15clinical areas, for which exceptions appliedData from the QMAS system on 8,229 English practicesData on practice and patient characteristics from the ONSand the GMS databaseInformed dissent could be accurately measured only for 37of the 62 indicators (measurement and outcome only)
Kontopantelis, Reeves Exception reporting under QOF
Heal
th S
cien
ces P
rimar
y Ca
re R
esea
rch
Grou
p
[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
Label Two
Label Three
Label Four
[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
[Add title, if necessary.]
[Add key point.] [Add description of key point.]
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RESULTS
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CONCLUSIONS
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[Graphic title]
RESULTS
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
[Add title, if necessary.]
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BackgroundMethodsResults
Summary
Analyses
For each practice and clinical indicator we calculated therate of exception reporting:
ERi = Ei/(Ei + Di)Ei , number of patients exception reported for that indicatorDi , number of patients meeting the criteria for the indicatorand not excepted by the practice
Calculated overall rates and separately for each of themain reasonsFocused on overall scores and informed dissentMultilevel multiple linear regression used to identifypractice & population predictors of exception reportingEstimated average financial gain from exception reporting
Kontopantelis, Reeves Exception reporting under QOF
Heal
th S
cien
ces P
rimar
y Ca
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esea
rch
Grou
p
[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
Label Two
Label Three
Label Four
[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
[Add title, if necessary.]
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CONCLUSIONS
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RESULTS
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
[Add title, if necessary.]
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BackgroundMethodsResults
Summary
Overall rates of exception reporting
In 2008/9 the median exception reporting rate across all 62clinical indicators was 4.5% (IQR: 3.4-5.8%)Median rates for individual indicators ranged from 0.0% (forseven indicators) to 24.4% (CHD 10: β blocker therapy forpatients with coronary heart disease)Median rates were generally lower for measurementindicators (2.4%) than for treatment (10.0%) andintermediate outcomes indicators (5.7%)For the 37 indicators for which reasons of ER wereascribable, median overall exception rate was 2.7% (IQR:1.9-3.9%)
Kontopantelis, Reeves Exception reporting under QOF
Heal
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cien
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rimar
y Ca
re R
esea
rch
Grou
p
[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
Label Two
Label Three
Label Four
[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
[Add title, if necessary.]
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CONCLUSIONS
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Rates of informed dissent exception reporting37 indicators
Median rate was 0.44% (IQR: 0.14-1.1%)10% of practices excepted over 2.2% of patients forinformed dissent and 1% of practices excepted over 5.7%Median rates for individual indicators ranged from 0.0% (25ind) to 1.2% (DM20, HbA1C control ≤ 7.5%)
Table 2| Proportion of exception reports attributable to each exception reporting category, by type of indicator
Type of indicator (%)
Reason for exception report AllIntermediate outcomeMeasurement
2.92.23.5Unknown*
40.645.935.9Logistical
7.616.20.0Clinical—contraindication
18.713.823.1Clinical—patient unsuitable
30.121.937.4Informed dissent
2 184 8111 026 0761 158 735Total No of exceptions
Based on 37 indicators for which reasons for exception reporting were ascribable (see table 1).*In these cases a “general” exception was applied to the patient and the exact reason for the exception report is not recorded.
No commercial reuse: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe
BMJ 2012;344:e2405 doi: 10.1136/bmj.e2405 (Published 17 April 2012) Page 9 of 11
RESEARCH
Kontopantelis, Reeves Exception reporting under QOF
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Grou
p
[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
Label Two
Label Three
Label Four
[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
[Add title, if necessary.]
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RESULTS
[Add title, if necessary.]
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CONCLUSIONS
[Add text as bulleted list or a paragraph.] [Add key point.]
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[Graphic title]
RESULTS
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[Replace, move, resize, or delete graphic, as necessary.] [Replace, move, resize, or delete graphic, as necessary.]
For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
[Add title, if necessary.]
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BackgroundMethodsResults
Summary
Rates of informed dissent exception reporting37 indicators
Figure 1: Proportion of patients exception reported by indicator and reason, 2008/9
For 37 indicators for which reasons for exception reporting were ascribable (see table 2a).
Indicators ordered by i) type of activity (measurement or outcome); ii) rate of exception reporting attributable to informed dissent.
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
Unknown
Logistical
Clinical - unsuitable
Clinical - contraindication
Informed dissent
[--------------------------------------Measurement----------------------------------] [------Outcome------]
Kontopantelis, Reeves Exception reporting under QOF
Heal
th S
cien
ces P
rimar
y Ca
re R
esea
rch
Grou
p
[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
Label Two
Label Three
Label Four
[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
[Add title, if necessary.]
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CONCLUSIONS
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Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Factors associated with exception reporting
Table 3| Results of regression analysis—factors associated with exception reporting rates
Informed dissentAll exceptions
Variable 95% CIP valueCoefficient95% CIP valueCoefficient
Indicator characteristics
−0.02 to −0.02<0.001−0.02−0.10 to −0.09<0.001−0.09Upper payment threshold (per 1% increase)
−0.14 to −0.07<0.001−0.10−0.15 to 0.050.321−0.05Indicator type (intermediate outcome)
0.00 to 0.000.0450.000.11 to 0.11<0.0010.11Maximum points/remuneration available
−0.04 to −0.04<0.001−0.04−0.64 to −0.62<0.001−0.63No of eligible patients (per 100 increase in disease register size)
Practice characteristics
-0.37 to −0.29<0.001−0.33−2.44 to −2.22<0.001−2.33Maximum points scored in previous year (2007/8)*
−0.00 to 0.000.449−0.00−0.01 to −0.00<0.001−0.00% of doctors aged ≥55†
−0.00 to 0.000.054−0.00−0.00 to 0.000.2440.00% of women doctors†
−0.05 to 0.070.7850.010.06 to 0.290.0040.17Personal Medical Services contract
0.06 to 0.08<0.0010.070.26 to 0.29<0.0010.28No of patients (per 1000 increase in list size)†
Patient and area characteristics
−0.00 to 0.010.3270.000.02 to 0.04<0.0010.03% of patients aged ≥65†
−0.02 to 0.010.685−0.00−0.02 to 0.020.987−0.00% of female patients†
−0.01 to −0.00<0.001−0.01−0.01 to 0.000.197−0.00% of patients from ethnic minority groups†
0.00 to 0.00<0.0010.00−0.00 to 0.000.1780.00Population density in locality†
Material deprivation in locality‡:
——————1st fourth (most affluent)
0.02 to 0.180.0210.10−0.02 to 0.280.0820.132nd fourth
0.09 to 0.27<0.0010.180.27 to 0.60<0.0010.443rd fourth
0.23 to 0.42<0.0010.330.51 to 0.87<0.0010.694th fourth (most deprived)
Based on 37 indicators for which reasons for exception reporting were ascribable (table 1).*For each specific indicator.†Data for 2006/7.‡Measured by index of deprivation 2007.
No commercial reuse: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe
BMJ 2012;344:e2405 doi: 10.1136/bmj.e2405 (Published 17 April 2012) Page 10 of 11
RESEARCH
Most influential factorwas previousperformance on theschemeFactors associatedwith higher levels ofinformed dissentexceptions werebroadly comparablewith those for overallexceptions
Kontopantelis, Reeves Exception reporting under QOF
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[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
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[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
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RESULTS
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Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Financial gain associated with exception reportingFigure 2: Total remuneration for all practices attributable to i) achievement of targets and ii) exception reporting, by indicator
For all 62 clinical indicators. Total remuneration is based on ‘population achievement’ rates. Remuneration attributable to achieving targets (grey columns) is based on ‘reported achievement’ rates. Remuneration attributable to exception reporting (black columns, with values in millions) is the difference between total remuneration and remuneration attributable to achieving target
£0
£10
£20
£30
£40
£50
£60
DM
11CK
D2CH
D5TH
Y2ST
R5D
M22
DM
5D
M16
CHD6
STR6
MH
4SM
O3D
M2
AST3
MH
6CH
D9ST
R7CH
D7EP
I7CA
N3
EPI6
STR1
2BP
4D
M12
DM
15D
M17
DM
9SM
O4D
M10
MH
7M
H5
STR8
DEP
1D
M13
CHD1
1AF
3ST
R10
DEM
2CK
D5ST
R13
COPD
10CH
D8D
M21
DM
18CO
PD11
HF2
AST6
DM
7CH
D2 HF3
DM
20CO
PD8
BP5
CKD3
AST8
CHD1
2EP
I8CO
PD12 AF
4CH
D10
MH
9D
EP2
Exception reporting
Achieving targets
Kontopantelis, Reeves Exception reporting under QOF
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[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
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[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
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RESULTS
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CONCLUSIONS
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RESULTS
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Financial gain associated with exception reportingoverall rates, 62 ind
Overall, 5.4% of clinical points scored by practices wereattributable to exception reportingThis equates to about £30,844,500 for all English practices
£3,834 for the average practice (£3,586-£4,093)£0.58 per patient
Cost varied widely by indicator, from £1,630 for DM11 (BPrecording for DM) to £4.5m for DEP2 (assessingdepression severity)DEP2 and MH9 (reviewing physical & social care forpeople with psychotic illness), accounted for £8.4m; over aquarter of the total cost associated with exception reporting
Kontopantelis, Reeves Exception reporting under QOF
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[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
Label Two
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Label Four
[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Financial gain associated with exception reportingoverall & informed dissent rates, 37 ind
4.9% of remuneration received was attributable to overallexception reportingThis equates to about £19,188,917 for all English practices
£2,386 for the average practice£0.36 per patient
The gain attributable to informed dissent exceptions was£2,406,500 nationally
£300 for the average practice (£244-£351)£0.05 per patient
Cost of informed dissent exceptions was relatively lowsince most applied to measurement indicators, whichattract less remuneration
Kontopantelis, Reeves Exception reporting under QOF
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[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
Label Two
Label Three
Label Four
[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
[Add title, if necessary.]
[Add key point.] [Add description of key point.]
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CONCLUSIONS
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RESULTS
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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BackgroundMethodsResults
Summary
Conclusions
Respecting a patient’s decision to refuse an investigationor treatment, even if considered wrong or irrational by theattending clinician, is central to medical professionalismWe found that rates of informed dissent in QOF are low,with little variation across the spectrum of deprivationThis suggests that activities incentivised in the scheme arebroadly acceptable to patientsThousands of patients expressed their wish not to receiveinterventions under the frameworkAt relatively low cost, the provision to exception reportenables patients’ voices to be heard and counters some ofthe critiques of the scheme
Kontopantelis, Reeves Exception reporting under QOF
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[Poster title]
ABSTRACT TITLE: [Add text here.]
BACKGROUND: [Add text here.]
OBJECTIVE: [Add text here.]
METHODS: [Add text here.]
RESULTS: [Add text here.]
CONCLUSIONS: [Add text here.]
BACKGROUND [Add title, if necessary.]
Label One
Label Two
Label Three
Label Four
[Replace the following names and titles with those of the actual contributors: Helge Hoeing, PhD1; Carol Philips, PhD2; Jonathan Haas, RN, BSN, MHA3, and Kimberly B. Zimmerman, MD4 1[Add affiliation for first contributor], 2[Add affiliation for second contributor], 3[Add affiliation for third contributor], 4[Add affiliation for fourth contributor]
OBJECTIVE
[Repeat objective from above.]
METHODS
[Add title, if necessary.]
[Add key point.] [Add description of key point.]
[Add key point.] [Add description of key point.]
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RESULTS
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CONCLUSIONS
[Add text as bulleted list or a paragraph.] [Add key point.]
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RESULTS
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For additional information please contact: [Name] [Department] [Institution or organization] [E-mail address]
Excepteur Sint Lkl
(n=212) Controls
(n=27)
Lorum Wt (kg) 18 (SD 10) 29 (SD 07)
Ipsum (wk) 31 (SD 5) 37 (SD 2)
Irure: B W H HB O
Unknown
79 (373%) 121 (571%)
2 (09%) 0
1 (05%) 9 (42%)
7 (259%) 18 (667%)
0 1 (37%) 1 (37%)
0
Proident F
Lorem
106 (50%) 101 (476%)
5 (24%)
17 (63%) 10 (37%)
Nostrud: N Y
Unknown
172 (811%) 22 (104%) 18 (85%)
26 (963%) 0
1 (37%)
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Appendix Thank you!
Doran T, Kontopantelis E, Fullwood C, et al. Exempting dissentingpatients from pay for performance schemes: retrospective analysis ofexception reporting in the UK Quality and Outcomes Framework. BMJ2012;344: doi: 10.1136/bmj.e2405
Comments, suggestions: [email protected]
Kontopantelis, Reeves Exception reporting under QOF
