[ { "phenotype_id": "PH535", "phenotype_version_id": 1070, "name": "Hypothyroidism", "definition": "Background:\n\nThe UK’s Quality and Outcomes Framework (QOF) was introduced in 2004/5, linking remuneration for general practices to recorded quality of care for chronic conditions, including diabetes mellitus. We assessed the effect of the incentives on recorded quality of care for diabetes patients and its variation by patient and practice characteristics.\n\n\nMethods: \n\nUsing the General Practice Research Database we selected a stratified sample of 148 English general practices in England, contributing data from 2000/1 to 2006/7, and obtained a random sample of 653 500 patients in which 23 920 diabetes patients identified. We quantified annually recorded quality of care at the patient-level, as measured by the 17 QOF diabetes indicators, in a composite score and analysed it longitudinally using an Interrupted Time Series design.\n\n\nResults:\n\nRecorded quality of care improved for all subgroups in the pre-incentive period. In the first year of the incentives, composite quality improved over-and-above this pre-incentive trend by 14.2% (13.7–14.6%). By the third year the improvement above trend was smaller, but still statistically significant, at 7.3% (6.7–8.0%). After 3 years of the incentives, recorded levels of care varied significantly for patient gender, age, years of previous care, number of co-morbid conditions and practice diabetes prevalence.\n\n\nConclusions:\n\nThe introduction of financial incentives was associated with improvements in the recorded quality of diabetes care in the first year. These improvements included some measures of disease control, but most captured only documentation of recommended aspects of clinical assessment, not patient management or outcomes of care. Improvements in subsequent years were more modest. Variation in care between population groups diminished under the incentives, but remained substantial in some cases.\n\n\n\n\n\n\n\n\n", "implementation": "", "publications": [ { "doi": null, "details": "Evangelos Kontopantelis, David Reeves, Jose M Valderas, Stephen Campbell, Tim Doran, Recorded quality of primary care for patients with diabetes in England before and after the introduction of a financial incentive scheme a longitudinal observational study. BMJ Qual Saf, 22, 53-64, 2013." } ], "validation": "", "citation_requirements": "", "created": "2021-10-06T16:24:06.665200Z", "author": "Evengelos Kontopantelis, David Reeves, Jose M Valderas, Stephen Campbell, Tim Doran", "collections": [ { "name": "ClinicalCodes Repository", "value": 25 }, { "name": "Phenotype Library", "value": 18 } ], "tags": null, "organisation": null, "world_access": 1, "updated": "2021-10-06T16:24:06.665229Z", "sex": [ { "name": "Both", "value": "3" } ], "type": [ { "name": "Disease or syndrome", "value": "2" } ], "ontology": null, "phenoflowid": "", "data_sources": [ { "name": "CPRD GOLD", "value": 5, "uid": "a29feafa-7bdd-44e9-b977-c9d26425e67f", "url": "https://healthdatagateway.org/en/dataset/694", "datasource_id": 694 } ], "coding_system": [ { "name": "Read codes v2", "value": 5 }, { "name": "OXMIS codes", "value": 15 } ], "event_date_range": "01/01/2000 - 31/12/2007", "concept_information": [ { "concept_id": 1921, "concept_version_id": 4980, "concept_name": "Hypothyroidism - Primary Care", "coding_system": { "id": 5, "name": "Read codes v2", "description": "Read codes v2" }, "phenotype_id": "PH535", "phenotype_version_id": 1070, "phenotype_name": "Hypothyroidism", "code_attribute_header": [ "Entity type", "Coding System (OXMIS Read)", "Category" ], "codes": [ { "code": "C03..00", "description": "Congenital hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C03y.00", "description": "Other specified congenital hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C03y000", "description": "Congenital hypothyroidism with diffuse goitre", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C03y100", "description": "Congenital hypothyroidism without goitre", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C03z.00", "description": "Congenital hypothyroidism NOS", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C04..00", "description": "Acquired hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C040.00", "description": "Postsurgical hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C040.11", "description": "Post ablative hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C041.00", "description": "Other postablative hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C041000", "description": "Irradiation hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C04..11", "description": "Myxoedema", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C04..12", "description": "Thyroid deficiency", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C04..13", "description": "Hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C041z00", "description": "Postablative hypothyroidism NOS", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C042.00", "description": "Iodine hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C043.00", "description": "Other iatrogenic hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C043000", "description": "Hypothyroidism resulting from para-aminosalicylic acid", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C043100", "description": "Hypothyroidism resulting from phenylbutazone", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C043200", "description": "Hypothyroidism resulting from resorcinol", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C043z00", "description": "Iatrogenic hypothyroidism NOS", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C044.00", "description": "Postinfectious hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C045.00", "description": "Acquired atrophy of thyroid", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C046.00", "description": "Autoimmune myxoedema", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C04y.00", "description": "Other acquired hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C04z.00", "description": "Hypothyroidism NOS", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C04z000", "description": "Premature puberty due to hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C04z100", "description": "Myxoedema coma", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C04z.11", "description": "Pretibial myxoedema - hypothyroid", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C04z.12", "description": "Thyroid insufficiency", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "C04z.13", "description": "Hypothyroid goitre, acquired", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "Cyu1100", "description": "[X]Other sp cified hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "diagnostic" } }, { "code": "F381400", "description": "Myasthenic syndrome due to hypothyroidism", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "symptom" } }, { "code": "f921.00", "description": "THYROXINE", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "drug" } }, { "code": "f922.00", "description": "THYROXINE tabs 50micrograms", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "drug" } }, { "code": "f923.00", "description": "THYROXINE tabs 100micrograms", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "Read", "Category": "drug" } } ] }, { "concept_id": 1922, "concept_version_id": 4982, "concept_name": "Hypothyroidism - Primary Care", "coding_system": { "id": 15, "name": "OXMIS codes", "description": "OXMIS codes" }, "phenotype_id": "PH535", "phenotype_version_id": 1070, "phenotype_name": "Hypothyroidism", "code_attribute_header": [ "Entity type", "Coding System (OXMIS Read)", "Category" ], "codes": [ { "code": "243", "description": "HYPOTHYROIDISM CONGENITAL", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "OXMIS", "Category": "diagnostic" } }, { "code": "244 AC", "description": "HYPOTHYROIDISM ACQUIRED", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "OXMIS", "Category": "diagnostic" } }, { "code": "244 AG", "description": "HYPOTHYROIDISM COMPENSATED", "attributes": { "Entity type": "res43: hypoth_kontopantelis_bmjqs2012", "Coding System (OXMIS Read)": "OXMIS", "Category": "diagnostic" } } ] } ], "status": 2, "doi": "https://doi.org/10.48533/n89y-4b42", "is_deleted": null, "publish_status": 2, "owner": "ieuan.scanlon", "template": { "id": 1, "name": "Clinical-Coded Phenotype", "description": "Phenotype definitions that are based on lists of clinical codes, or algorithms using clinical codes.", "version_id": 1 }, "versions": [ { "version_id": 1070, "version_name": "Hypothyroidism", "version_date": "2021-10-06T16:24:06.687567Z", "is_published": true, "is_latest": true } ] } ]