The Experts below are selected from a list of 186 Experts worldwide ranked by ideXlab platform
Helen Lester - One of the best experts on this subject based on the ideXlab platform.
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exempting dissenting patients from pay for performance schemes retrospective analysis of Exception Reporting in the uk quality and outcomes framework
BMJ, 2012Co-Authors: Tim Doran, Helen Lester, Evangelos Kontopantelis, Catherine Fullwood, Jose M Valderas, Stephen CampbellAbstract:Objective To 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. Design Retrospective analysis. Setting Data for 2008-9 extracted from the clinical computing systems of general practices in England. Participants 8229 English family practices. Main outcome measures Rates 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. Results The 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. Conclusions The 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.
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Exception Reporting in the Quality and Outcomes Framework: views of practice staff – a qualitative study
British Journal of General Practice, 2011Co-Authors: Stephen Campbell, Kerin Hannon, Helen LesterAbstract:Background Exception Reporting allows practices to exclude eligible patients from indicators or an entire clinical domain of the Quality and Outcomes Framework (QOF). It is a source of contention, viewed by some as a ‘gaming’ mechanism. Aim To explore GP and practice staff views and experiences of Exception Reporting in the QOF. Design of study Qualitative semi-structured interviews. Setting Interviews with 24 GPs, 20 practice managers, 13 practice nurses, and nine other staff were conducted in 27 general practices in the UK. Method Semi-structured interviews, analysed using open explorative thematic coding. Results Exception Reporting was seen as a clinically necessary part of the QOF. Exempting patients, particularly for discretionary reasons, was seen as an ‘Exception to the rule’ that was justified either in terms of practising patient-centred care within a framework of population-based health measures or because of the poor face validity of the indicators. Rates in all practices were described as minimal and the threat of external scrutiny from primary care trusts kept rates low. However, GPs were happy to defend using discretionary Exception codes for individual patients. Exception Reporting was used, particularly at the end of the payment year, to meet unmet targets and to prevent the practice being penalised financially. Overt gaming was seen as something done by ‘other’ practices. Only two GPs admitted to occasional inappropriate Exception Reporting. Conclusion Exception Reporting is seen by most GPs and practice staff as an important and defensible safeguard against inappropriate treatment or over-treatment of patients. However, a minority of practitioners also saw it as a gaming mechanism.
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Exception Reporting in the quality and outcomes framework views of practice staff a qualitative study
British Journal of General Practice, 2011Co-Authors: Stephen Campbell, Kerin Hannon, Helen LesterAbstract:Background Exception Reporting allows practices to exclude eligible patients from indicators or an entire clinical domain of the Quality and Outcomes Framework (QOF). It is a source of contention, viewed by some as a ‘gaming’ mechanism. Aim To explore GP and practice staff views and experiences of Exception Reporting in the QOF. Design of study Qualitative semi-structured interviews. Setting Interviews with 24 GPs, 20 practice managers, 13 practice nurses, and nine other staff were conducted in 27 general practices in the UK. Method Semi-structured interviews, analysed using open explorative thematic coding. Results Exception Reporting was seen as a clinically necessary part of the QOF. Exempting patients, particularly for discretionary reasons, was seen as an ‘Exception to the rule’ that was justified either in terms of practising patient-centred care within a framework of population-based health measures or because of the poor face validity of the indicators. Rates in all practices were described as minimal and the threat of external scrutiny from primary care trusts kept rates low. However, GPs were happy to defend using discretionary Exception codes for individual patients. Exception Reporting was used, particularly at the end of the payment year, to meet unmet targets and to prevent the practice being penalised financially. Overt gaming was seen as something done by ‘other’ practices. Only two GPs admitted to occasional inappropriate Exception Reporting. Conclusion Exception Reporting is seen by most GPs and practice staff as an important and defensible safeguard against inappropriate treatment or over-treatment of patients. However, a minority of practitioners also saw it as a gaming mechanism.
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Exception Reporting in the quality and outcomes framework
2011Co-Authors: Stephen Campbell, Kerin Hannon, Helen LesterAbstract:Background Exception Reporting allows practices to exclude eligible patients from indicators or an entire clinical domain of the Quality and Outcomes Framework (QOF). It is a source of contention, viewed by some as a ‘gaming’ mechanism. Aim
Renee Mcculloch - One of the best experts on this subject based on the ideXlab platform.
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G98 Exception Reporting at great ormond street hospital – building on junior doctors experiences
Archives of Disease in Childhood, 2018Co-Authors: Glp Manning, J Hassell, E Parish, S Ottaway, J Poisson, S Sharma, Renee MccullochAbstract:Aims The new English/Welsh Junior Doctor (JD) contract introduces a powerful tool for positive change – the Exception Report (ER). Following a staged introduction, ER has been available to all JDs (including those not in training), throughout Great Ormond Street Hospital (GOSH) since June 2017. Initial rates of ER have been low, with concerns of JD disillusionment. This project aims to improve the number of submitted ERs with secondary analysis of ER outcome. Methods A process map identified primary drivers of Reporting; Educational Supervisor (ES) engagement; and systemic change. Access to ER systems was improved by incorporating with the postgraduate medical education (PGME) smartphone app. ER was decoupled from ES by allocating departmental ER consultant leads. Ideas on local Exception causes; barriers to Reporting; and potential solutions were obtained from a JD focus group, which aided production of a guideline for ER leads to address ER root causes. After promoting ER at hospital induction, further interventions were targeted by surveying all JDs on personal experience of Exceptions; ER processes; and opinions on Reporting. Progress was measured by graphing ER numbers, broken down by Reporting department. Future change ideas included a PGME-led awareness campaign, including website, e-newsletter, (P), video and podcast facets; publicity of previous work on JD perspectives; creation of a framework, targeted at JDs, encouraging junior-lead solutions when Reporting; supplementation of PGME ES resources; and targeted signposting towards currently-available courses and learning resources. Results 56 ERs were submitted during Mar-Sep 2017, leading to plans to redesign one department’s rota, with financial compensation for three JDs in multiple departments. An additional fellow is being recruited into another department following a JD-initiated business case including, amongst other arguments, ER submissions. No fines have been levied. Multiple interventions are ongoing, with monthly plan-do-study-act (PDSA) cycles planned to aid continued improvement, and to ensure all JDs at GOSH feel empowered to submit ERs. Conclusions ER should be used positively to identify system issues, and early usage at GOSH has demonstrated ER to both support and initiate constructive departmental change. Impact from current interventions is awaited, as departments harness the potential of the ER process.
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g98 Exception Reporting at great ormond street hospital building on junior doctors experiences
Archives of Disease in Childhood, 2018Co-Authors: Glp Manning, J Hassell, E Parish, S Ottaway, J Poisson, S Sharma, Renee MccullochAbstract:Aims The new English/Welsh Junior Doctor (JD) contract introduces a powerful tool for positive change – the Exception Report (ER). Following a staged introduction, ER has been available to all JDs (including those not in training), throughout Great Ormond Street Hospital (GOSH) since June 2017. Initial rates of ER have been low, with concerns of JD disillusionment. This project aims to improve the number of submitted ERs with secondary analysis of ER outcome. Methods A process map identified primary drivers of Reporting; Educational Supervisor (ES) engagement; and systemic change. Access to ER systems was improved by incorporating with the postgraduate medical education (PGME) smartphone app. ER was decoupled from ES by allocating departmental ER consultant leads. Ideas on local Exception causes; barriers to Reporting; and potential solutions were obtained from a JD focus group, which aided production of a guideline for ER leads to address ER root causes. After promoting ER at hospital induction, further interventions were targeted by surveying all JDs on personal experience of Exceptions; ER processes; and opinions on Reporting. Progress was measured by graphing ER numbers, broken down by Reporting department. Future change ideas included a PGME-led awareness campaign, including website, e-newsletter, (P), video and podcast facets; publicity of previous work on JD perspectives; creation of a framework, targeted at JDs, encouraging junior-lead solutions when Reporting; supplementation of PGME ES resources; and targeted signposting towards currently-available courses and learning resources. Results 56 ERs were submitted during Mar-Sep 2017, leading to plans to redesign one department’s rota, with financial compensation for three JDs in multiple departments. An additional fellow is being recruited into another department following a JD-initiated business case including, amongst other arguments, ER submissions. No fines have been levied. Multiple interventions are ongoing, with monthly plan-do-study-act (PDSA) cycles planned to aid continued improvement, and to ensure all JDs at GOSH feel empowered to submit ERs. Conclusions ER should be used positively to identify system issues, and early usage at GOSH has demonstrated ER to both support and initiate constructive departmental change. Impact from current interventions is awaited, as departments harness the potential of the ER process.
Stephen Campbell - One of the best experts on this subject based on the ideXlab platform.
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exempting dissenting patients from pay for performance schemes retrospective analysis of Exception Reporting in the uk quality and outcomes framework
BMJ, 2012Co-Authors: Tim Doran, Helen Lester, Evangelos Kontopantelis, Catherine Fullwood, Jose M Valderas, Stephen CampbellAbstract:Objective To 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. Design Retrospective analysis. Setting Data for 2008-9 extracted from the clinical computing systems of general practices in England. Participants 8229 English family practices. Main outcome measures Rates 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. Results The 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. Conclusions The 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.
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Exception Reporting in the Quality and Outcomes Framework: views of practice staff – a qualitative study
British Journal of General Practice, 2011Co-Authors: Stephen Campbell, Kerin Hannon, Helen LesterAbstract:Background Exception Reporting allows practices to exclude eligible patients from indicators or an entire clinical domain of the Quality and Outcomes Framework (QOF). It is a source of contention, viewed by some as a ‘gaming’ mechanism. Aim To explore GP and practice staff views and experiences of Exception Reporting in the QOF. Design of study Qualitative semi-structured interviews. Setting Interviews with 24 GPs, 20 practice managers, 13 practice nurses, and nine other staff were conducted in 27 general practices in the UK. Method Semi-structured interviews, analysed using open explorative thematic coding. Results Exception Reporting was seen as a clinically necessary part of the QOF. Exempting patients, particularly for discretionary reasons, was seen as an ‘Exception to the rule’ that was justified either in terms of practising patient-centred care within a framework of population-based health measures or because of the poor face validity of the indicators. Rates in all practices were described as minimal and the threat of external scrutiny from primary care trusts kept rates low. However, GPs were happy to defend using discretionary Exception codes for individual patients. Exception Reporting was used, particularly at the end of the payment year, to meet unmet targets and to prevent the practice being penalised financially. Overt gaming was seen as something done by ‘other’ practices. Only two GPs admitted to occasional inappropriate Exception Reporting. Conclusion Exception Reporting is seen by most GPs and practice staff as an important and defensible safeguard against inappropriate treatment or over-treatment of patients. However, a minority of practitioners also saw it as a gaming mechanism.
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Exception Reporting in the quality and outcomes framework views of practice staff a qualitative study
British Journal of General Practice, 2011Co-Authors: Stephen Campbell, Kerin Hannon, Helen LesterAbstract:Background Exception Reporting allows practices to exclude eligible patients from indicators or an entire clinical domain of the Quality and Outcomes Framework (QOF). It is a source of contention, viewed by some as a ‘gaming’ mechanism. Aim To explore GP and practice staff views and experiences of Exception Reporting in the QOF. Design of study Qualitative semi-structured interviews. Setting Interviews with 24 GPs, 20 practice managers, 13 practice nurses, and nine other staff were conducted in 27 general practices in the UK. Method Semi-structured interviews, analysed using open explorative thematic coding. Results Exception Reporting was seen as a clinically necessary part of the QOF. Exempting patients, particularly for discretionary reasons, was seen as an ‘Exception to the rule’ that was justified either in terms of practising patient-centred care within a framework of population-based health measures or because of the poor face validity of the indicators. Rates in all practices were described as minimal and the threat of external scrutiny from primary care trusts kept rates low. However, GPs were happy to defend using discretionary Exception codes for individual patients. Exception Reporting was used, particularly at the end of the payment year, to meet unmet targets and to prevent the practice being penalised financially. Overt gaming was seen as something done by ‘other’ practices. Only two GPs admitted to occasional inappropriate Exception Reporting. Conclusion Exception Reporting is seen by most GPs and practice staff as an important and defensible safeguard against inappropriate treatment or over-treatment of patients. However, a minority of practitioners also saw it as a gaming mechanism.
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Exception Reporting in the quality and outcomes framework
2011Co-Authors: Stephen Campbell, Kerin Hannon, Helen LesterAbstract:Background Exception Reporting allows practices to exclude eligible patients from indicators or an entire clinical domain of the Quality and Outcomes Framework (QOF). It is a source of contention, viewed by some as a ‘gaming’ mechanism. Aim
Christopher Millett - One of the best experts on this subject based on the ideXlab platform.
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Impact of `Stretch' Targets for Cardiovascular Disease Management within a Local Pay-for-Performance Programme
PLOS ONE, 2015Co-Authors: Utz J. Pape, Kit Huckvale, Azeem Majeed, Christopher MillettAbstract:Pay-for-performance programs are often aimed to improve the management of chronic diseases. We evaluate the impact of a local pay for performance programme (QOF+), which rewarded financially more ambitious quality targets (‘stretch targets’) than those used nationally in the Quality and Outcomes Framework (QOF). We focus on targets for intermediate outcomes in patients with cardiovascular disease and diabetes. A difference-in-difference approach is used to compare practice level achievements before and after the introduction of the local pay for performance program. In addition, we analysed patient-level data on Exception Reporting and intermediate outcomes utilizing an interrupted time series analysis. The local pay for performance program led to significantly higher target achievements (hypertension: p-value
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Uptake of the NHS health check programme in an urban setting
Family Practice, 2013Co-Authors: Matej Artac, Andrew R.h. Dalton, Josip Car, Azeem Majeed, Kit Huckvale, Christopher MillettAbstract:BACKGROUND: The NHS Health Check programme aims to improve prevention, early diagnosis and management of cardiovascular disease (CVD) in England. High and equitable uptake is essential for the programme to effectively reduce the CVD burden. OBJECTIVES: Assessing the impact of a local financial incentive scheme on uptake and statin prescribing in the first 2 years of the programme. METHODS: Cross-sectional study using data from electronic medical records of general practices in Hammersmith and Fulham, London on all patients aged 40-74 years. We assessed uptake of complete Health Check, exclusion of patients from the programme (Exception Reporting) and statin prescriptions in patients confirmed with high CVD risk. RESULTS: The Health Check uptake was 32.7% in Year 1 and 20.0% in Year 2. Older patients had higher uptake of Health Check than younger (65- to 74-year-old patients: Year 1 adjusted odds ratio (AOR) 2.05 (1.67-2.52) & Year 2 AOR 2.79 (2.49-3.12) compared with 40- to 54-year-old patients). The percentage of confirmed high risk patients prescribed a statin was 17.7% before and 52.9% after the programme. There was a marked variation in Health Check uptake, Exception Reporting and statin prescribing between practices. CONCLUSIONS: Uptake of the Health Check was low in the first year in patients with estimated high risk despite financial incentives to general practices; although this matched the national required rate in second year. Further evaluations for cost and clinical effectiveness of the programme are needed to clarify whether this spending is appropriate, and to assess the impact of financial incentives on programme performance.
Glp Manning - One of the best experts on this subject based on the ideXlab platform.
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G98 Exception Reporting at great ormond street hospital – building on junior doctors experiences
Archives of Disease in Childhood, 2018Co-Authors: Glp Manning, J Hassell, E Parish, S Ottaway, J Poisson, S Sharma, Renee MccullochAbstract:Aims The new English/Welsh Junior Doctor (JD) contract introduces a powerful tool for positive change – the Exception Report (ER). Following a staged introduction, ER has been available to all JDs (including those not in training), throughout Great Ormond Street Hospital (GOSH) since June 2017. Initial rates of ER have been low, with concerns of JD disillusionment. This project aims to improve the number of submitted ERs with secondary analysis of ER outcome. Methods A process map identified primary drivers of Reporting; Educational Supervisor (ES) engagement; and systemic change. Access to ER systems was improved by incorporating with the postgraduate medical education (PGME) smartphone app. ER was decoupled from ES by allocating departmental ER consultant leads. Ideas on local Exception causes; barriers to Reporting; and potential solutions were obtained from a JD focus group, which aided production of a guideline for ER leads to address ER root causes. After promoting ER at hospital induction, further interventions were targeted by surveying all JDs on personal experience of Exceptions; ER processes; and opinions on Reporting. Progress was measured by graphing ER numbers, broken down by Reporting department. Future change ideas included a PGME-led awareness campaign, including website, e-newsletter, (P), video and podcast facets; publicity of previous work on JD perspectives; creation of a framework, targeted at JDs, encouraging junior-lead solutions when Reporting; supplementation of PGME ES resources; and targeted signposting towards currently-available courses and learning resources. Results 56 ERs were submitted during Mar-Sep 2017, leading to plans to redesign one department’s rota, with financial compensation for three JDs in multiple departments. An additional fellow is being recruited into another department following a JD-initiated business case including, amongst other arguments, ER submissions. No fines have been levied. Multiple interventions are ongoing, with monthly plan-do-study-act (PDSA) cycles planned to aid continued improvement, and to ensure all JDs at GOSH feel empowered to submit ERs. Conclusions ER should be used positively to identify system issues, and early usage at GOSH has demonstrated ER to both support and initiate constructive departmental change. Impact from current interventions is awaited, as departments harness the potential of the ER process.
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g98 Exception Reporting at great ormond street hospital building on junior doctors experiences
Archives of Disease in Childhood, 2018Co-Authors: Glp Manning, J Hassell, E Parish, S Ottaway, J Poisson, S Sharma, Renee MccullochAbstract:Aims The new English/Welsh Junior Doctor (JD) contract introduces a powerful tool for positive change – the Exception Report (ER). Following a staged introduction, ER has been available to all JDs (including those not in training), throughout Great Ormond Street Hospital (GOSH) since June 2017. Initial rates of ER have been low, with concerns of JD disillusionment. This project aims to improve the number of submitted ERs with secondary analysis of ER outcome. Methods A process map identified primary drivers of Reporting; Educational Supervisor (ES) engagement; and systemic change. Access to ER systems was improved by incorporating with the postgraduate medical education (PGME) smartphone app. ER was decoupled from ES by allocating departmental ER consultant leads. Ideas on local Exception causes; barriers to Reporting; and potential solutions were obtained from a JD focus group, which aided production of a guideline for ER leads to address ER root causes. After promoting ER at hospital induction, further interventions were targeted by surveying all JDs on personal experience of Exceptions; ER processes; and opinions on Reporting. Progress was measured by graphing ER numbers, broken down by Reporting department. Future change ideas included a PGME-led awareness campaign, including website, e-newsletter, (P), video and podcast facets; publicity of previous work on JD perspectives; creation of a framework, targeted at JDs, encouraging junior-lead solutions when Reporting; supplementation of PGME ES resources; and targeted signposting towards currently-available courses and learning resources. Results 56 ERs were submitted during Mar-Sep 2017, leading to plans to redesign one department’s rota, with financial compensation for three JDs in multiple departments. An additional fellow is being recruited into another department following a JD-initiated business case including, amongst other arguments, ER submissions. No fines have been levied. Multiple interventions are ongoing, with monthly plan-do-study-act (PDSA) cycles planned to aid continued improvement, and to ensure all JDs at GOSH feel empowered to submit ERs. Conclusions ER should be used positively to identify system issues, and early usage at GOSH has demonstrated ER to both support and initiate constructive departmental change. Impact from current interventions is awaited, as departments harness the potential of the ER process.
