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Quality of Care in the United Kingdom after Removal of Financial Incentives

Overview of attention for article published in New England Journal of Medicine, September 2018
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (99th percentile)
  • High Attention Score compared to outputs of the same age and source (93rd percentile)

Mentioned by

news
65 news outlets
blogs
3 blogs
twitter
538 tweeters
reddit
1 Redditor

Citations

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15 Dimensions

Readers on

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76 Mendeley
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Title
Quality of Care in the United Kingdom after Removal of Financial Incentives
Published in
New England Journal of Medicine, September 2018
DOI 10.1056/nejmsa1801495
Pubmed ID
Authors

Mark Minchin, Martin Roland, Judith Richardson, Shaun Rowark, Bruce Guthrie

Abstract

Background The benefits of pay-for-performance schemes in improving the quality of care remain uncertain. There is little information on the effect of removing incentives from existing pay-for-performance schemes. Methods We conducted interrupted time-series analyses of electronic medical record (EMR) data from 2010 to 2017 for 12 quality-of-care indicators in the United Kingdom's Quality and Outcomes Framework for which financial incentives were removed in 2014 and 6 indicators for which incentives were maintained. We estimated the effects of removing incentives on changes in performance on quality-of-care measures. Results Complete longitudinal data were available for 2819 English primary care practices with more than 20 million registered patients. There were immediate reductions in documented quality of care for all 12 indicators in the first year after the removal of financial incentives. Reductions were greatest for indicators related to health advice, with a reduction of 62.3 percentage points (95% confidence interval [CI], -65.6 to -59.0) in EMR documentation of lifestyle counseling for patients with hypertension. Changes were smaller for indicators involving clinical actions that automatically update the EMR, such as laboratory testing, with a reduction of 10.7 percentage points (95% CI, -13.6 to -7.8) in control of cholesterol in patients with coronary heart disease and 12.1 percentage points (95% CI, -13.6 to -10.6) for thyroid-function testing in patients with hypothyroidism. There was little change in performance on the 6 quality measures for which incentives were maintained. Conclusions Removal of financial incentives was associated with an immediate decline in performance on quality measures. In part, the decline probably reflected changes in EMR documentation, but declines on measures involving laboratory testing suggest that incentive removal also changed the care delivered.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 76 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 76 100%

Demographic breakdown

Readers by professional status Count As %
Other 13 17%
Unspecified 12 16%
Researcher 10 13%
Student > Master 8 11%
Student > Ph. D. Student 8 11%
Other 25 33%
Readers by discipline Count As %
Medicine and Dentistry 32 42%
Unspecified 19 25%
Nursing and Health Professions 6 8%
Biochemistry, Genetics and Molecular Biology 4 5%
Pharmacology, Toxicology and Pharmaceutical Science 3 4%
Other 12 16%

Attention Score in Context

This research output has an Altmetric Attention Score of 888. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 29 October 2019.
All research outputs
#5,357
of 13,755,459 outputs
Outputs from New England Journal of Medicine
#284
of 25,745 outputs
Outputs of similar age
#241
of 265,492 outputs
Outputs of similar age from New England Journal of Medicine
#18
of 267 outputs
Altmetric has tracked 13,755,459 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 99th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 25,745 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 64.9. This one has done particularly well, scoring higher than 98% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 265,492 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 99% of its contemporaries.
We're also able to compare this research output to 267 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 93% of its contemporaries.