ArticleBMJ (Clinical research ed.)2012
Exempting dissenting patients from pay for performance schemes: retrospective analysis of exception reporting in the UK Quality and Outcomes Framework.
Article in BMJ (Clinical research ed.), 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Design and effects of outcome-based payment models in healthcare: a systematic review.The European journal of health economics : HEPAC : health economics in prevention and care · 2019Pooled it
- Socioeconomic inequalities in the quality of care for long-term conditions in England: retrospective, observational study of electronic primary care records from the Clinical Practice Research Datalink.Journal of epidemiology and community health · 2026Observational
- From exception to insight: a phenomenological study of quality managers' perspectives on the individual appeals in the National Healthcare Quality Program.Israel journal of health policy research · 2026Article
- Characteristics of people with severe mental illness excluded from incentivised physical health checks in the UK: electronic healthcare record study.The British journal of psychiatry : the journal of mental science · 2026Article
- Ethnic inequities in the patterns of personalized care adjustments for 'informed dissent' and 'patient unsuitable': a retrospective study using Clinical Practice Research Datalink.Journal of public health (Oxford, England) · 2023Article
- Healthcare Equity and Commissioning: A Four-Year National Analysis of Portuguese Primary Healthcare Units.International journal of environmental research and public health · 2022Article
- Deprivation and primary care funding in Greater Manchester after devolution: a cross-sectional analysis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019Article
- Article
- Incentivised chronic disease management and the inverse equity hypothesis: findings from a longitudinal analysis of Scottish primary care practice-level data.BMC medicine · 2017Article
- The Challenges of Measuring, Improving, and Reporting Quality in Primary Care.Annals of family medicine · 2017Article
- Article
- Associations between exemption and survival outcomes in the UK's primary care pay-for-performance programme: a retrospective cohort study.BMJ quality & safety · 2016Article
- How a universal health system reduces inequalities: lessons from England.Journal of epidemiology and community health · 2016Article
- Improving the Quality of Quality Measurement.Journal of general internal medicine · 2016Article
- Article
- How Financial and Reputational Incentives Can Be Used to Improve Medical Care.Health services research · 2015Article
- Does the quality and outcomes framework reduce psychiatric admissions in people with serious mental illness? A regression analysis.BMJ open · 2015Article
- Pay-for-performance and primary care physicians: lessons from the U.K Quality and Outcomes Framework for local incentive schemes.Journal of the Royal Society of Medicine · 2015Article
- The influence of primary care quality on hospital admissions for people with dementia in England: a regression analysis.PloS one · 2015Article
- Impact of 'stretch' targets for cardiovascular disease management within a local pay-for-performance programme.PloS one · 2015Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
objectiveTo 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.
designRetrospective analysis.
settingData for 2008-9 extracted from the clinical computing systems of general practices in England.
participants8229 English family practices.
main outcome measuresRates 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.
resultsThe 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 £30,844,500 (€36,877,700; $49,053,200) (£0.58 per patient), with two indicators accounting for a quarter of this additional cost.
conclusionsThe 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.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.