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. 2019 Mar;69(680):e154-e163.
doi: 10.3399/bjgp19X701513. Epub 2019 Feb 25.

Incentive schemes to increase dementia diagnoses in primary care in England: a retrospective cohort study of unintended consequences

Dan Liu  1 , Emily Green  2 , Panagiotis Kasteridis  1 , Maria Goddard  1 , Rowena Jacobs  1 , Raphael Wittenberg  3 , Anne Mason  1
Affiliations

Incentive schemes to increase dementia diagnoses in primary care in England: a retrospective cohort study of unintended consequences

Dan Liu et al. Br J Gen Pract. 2019 Mar.

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.

Keywords: dementia; incentives; primary health care; programme evaluation; reimbursement.

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Figures

Figure 1.
Figure 1.
Trends in the quality of primary care for long-term conditions in QOF (excluding dementia): variation by participation in the schemes. DES18 = Directed Enhanced Service 18. DIS = Dementia Identification Scheme. QOF = Quality and Outcomes Framework. Light grey: DES18: April 2013 to March 2016. Dark grey: DIS: October 2014 to March 2015.
Figure 2.
Figure 2.
Trends of outcomes for DES18 scheme. DES18 = Directed Enhanced Service 18. QOF = Quality and Outcomes Framework. Light grey: DES18: April 2013 to March 2016. Dark grey: DIS: October 2014 to March 2015.
Figure 3.
Figure 3.
Trends of outcomes for DIS scheme. DES18 = Directed Enhanced Service 18. QOF = Quality and Outcomes Framework. DIS = Dementia Identification Scheme. Light grey: DES18: April 2013 to March 2016. Dark grey: DIS: October 2014 to March 2015.
See this image and copyright information in PMC

References

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    1. Alzheimer’s Society Dementia UK: update. 2014 https://www.alzheimers.org.uk/download/downloads/id/2323/dementia_uk_upd... (accessed 14 Feb 2019).
    1. Department of Health Prime Minister’s challenge on dementia: delivering major improvements in dementia care and research by 2015. 2012 https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil... (accessed 14 Feb 2019).
    1. NHS Commissioning Board . Enhanced service specification: facilitating timely diagnosis and support for people with dementia. NHS; 2013. https://www.england.nhs.uk/wp-content/uploads/2013/03/ess-dementia.pdf (accessed 14 Feb 2018)
    1. NHS England . Enhanced service specification: facilitating timely diagnosis and support for people with dementia. NHS England; 2014. https://www.england.nhs.uk/wp-content/uploads/2014/03/timely-diag-ppl-de... (accessed 14 Feb 2019).

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