Liu, Dan, Green, Emily, Kasteridis, Panagiotis, Goddard, Maria, Jacobs, Rowena, Wittenberg, Raphael 
ORCID: 0000-0003-3096-2721 and Mason, Anne
(2019)
Incentive schemes to increase dementia diagnoses in primary care in England: a retrospective cohort study of unintended consequences.
British Journal of General Practice, 69 (680).
e154-e163.
ISSN 0960-1643
Abstract
Background The UK government introduced two financial incentive schemes for primary care to tackle underdiagnosis in dementia: The 3-year Directed Enhanced Service 18 (DES18) and the 6-month Dementia Identification Scheme (DIS). The schemes appear to have been effective in boosting dementia diagnosis rates, but their unintended effects are unknown. Aim To identify and quantify unintended consequences associated with the DES18 and DIS schemes. Design and setting A retrospective cohort quantitative study of 7079 English primary care practices. Method Potential unintended effects of financial incentive schemes, both positive and negative, were identified from a literature review. A practice-level dataset covering the period 2006/2007 to 2015/2016 was constructed. Difference-in-differences analysis was employed to test the effects of the incentive schemes on quality measures from the Quality and Outcomes Framework (QOF); and four measures of patient experience from the GP Patient Survey (GPPS): patient-centred care, access to care, continuity of care, and the doctor-patient relationship. The researchers controlled for effects of the contemporaneous hospital incentive scheme for dementia and for practice characteristics. Results National practice participation rates in DES18 and DIS were 98.5% and 76% respectively. Both schemes were associated not only with a positive impact on QOF quality outcomes, but also with negative impacts on some patient experience indicators. Conclusion The primary care incentive schemes for dementia appear to have enhanced QOF performance for the dementia review, and have had beneficial spillover effects on QOF performance in other clinical areas. However, the schemes may have had negative impacts on several aspects of patient experience.
| Item Type: | Article |
|---|---|
| Additional Information: | © 2019 British Journal of General Practice |
| Divisions: | Care Policy and Evaluation Centre |
| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine |
| Date Deposited: | 20 Mar 2019 15:00 |
| Last Modified: | 12 Dec 2024 01:42 |
| URI: | http://eprints.lse.ac.uk/id/eprint/100299 |
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