Volume 47 | Number 3pt1 | June 2012

Abstract List

Evangelos Kontopantelis Ph.D., Tim Doran, Hugh Gravelle Ph.D., Rosalind Goudie M.Sc., Luigi Siciliani Ph.D., Matt Sutton


To analyze the effect of setting higher targets, in a primary care pay‐for‐performance scheme, on rates of influenza immunization and exception reporting.

Study Setting

The uality and utcomes ramework links financial rewards for family practices to four separate influenza immunization rates for patients with coronary heart disease (), chronic obstructive pulmonary disease, diabetes, and stroke. There is no additional payment for immunization rates above an upper threshold. Patients for whom immunization would be inappropriate can be excepted from the practice for the calculation of the practice immunization rate.


Practice‐level information on immunizations and exceptions extracted from electronic records of all practices in ngland 2004/05 to 2009/10 ( = 8,212–8,403).

Study Design

Longitudinal random effect multilevel linear regressions comparing changes in practice immunization and exception rates for the four chronic conditions before and after the increase in the upper threshold immunization rate for patients in 2006/07.

Principal Findings

The 5 percent increase in the upper payment threshold for was associated with increases in the proportion of immunized patients (0.41 percent, : 0.25–0.56 percent), and exception was reported (0.26 percent, : 0.12–0.40 percent).


Making quality targets more demanding can not only lead to improvement in quality of care but can also have other consequences.