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Financial incentives improve recognition but not treatment of cardiovascular risk factors in severe mental illness

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  • Carol L Wilson
  • Kirsty M Rhodes
  • Rupert A Payne

Abstract

Objectives: Severe mental illness (SMI) is associated with premature cardiovascular disease, prompting the UK primary care payment-for-performance system (Quality and Outcomes Framework, QOF) to incentivise annual physical health reviews. This study aimed to assess the QOF’s impact on detection and treatment of cardiovascular risk factors in people with SMI. Methods: A retrospective open cohort study of UK general practice was conducted between 1996 and 2014, using segmented logistic regression with 2004 and 2011 as break points, reflecting the introduction of relevant QOF incentives in these years. 67239 SMI cases and 359951 randomly-selected unmatched controls were extracted from the Clinical Practice Research Datalink (CPRD). Results: There was strong evidence (p≤0.015) the 2004 QOF indicator (general health) resulted in an immediate increase in recording of elevated cholesterol (odds ratio 1.37 (95% confidence interval 1.24 to 1.51)); obesity (OR 1.21 (1.06 to 1.38)); and hypertension (OR 1.19 (1.04 to 1.38)) in the SMI group compared with the control group, which was sustained in subsequent years. Similar findings were found for diabetes, although the evidence was weaker (p = 0.059; OR 1.21 (0.99 to 1.49)). There was evidence (p

Suggested Citation

  • Carol L Wilson & Kirsty M Rhodes & Rupert A Payne, 2017. "Financial incentives improve recognition but not treatment of cardiovascular risk factors in severe mental illness," PLOS ONE, Public Library of Science, vol. 12(6), pages 1-11, June.
    • Handle: RePEc:plo:pone00:0179392
    DOI: 10.1371/journal.pone.0179392
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