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This is related to legal framework schemes changing frequently and the feed-in tariff for electricity generation, which is becoming unpredictable.
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As a result, our estimate of the effect of the Quality and Outcomes Framework scheme in the main analysis is likely to be conservative.
We found relative reductions in rates of emergency admissions for conditions incentivised under the Quality and Outcomes Framework scheme, particularly for coronary heart disease and stroke.
One potential explanation is that previous interventions that might have influenced patterns of admission were reinforced with the introduction of the Quality and Outcomes Framework scheme.
Main outcome measures Year specific differences between trend adjusted emergency hospital admission rates for incentivised ACSCs before and after the introduction of the Quality and Outcomes Framework scheme and two comparators: non-incentivised ACSCs and non-ACSCs.
Our supplementary analysis, which considered only the underlying trend in admissions for the incentivised ACSCs, showed a larger reduction, which also coincided with the introduction of the Quality and Outcomes Framework scheme.
By the seventh year of the Quality and Outcomes Framework scheme (2010/11), the trend adjusted rate for incentivised ACSCs was 8.0% (6.9% to 9.1%) less than for non-incentivised ACSCs.
The effect of the Quality and Outcomes Framework scheme on trend adjusted emergency admissions was similar for practices with above or below median values for income deprivation (see supplementary tables A2 and A3 and figures A1 and A2).
We estimated the impact of the Quality and Outcomes Framework scheme using the difference between the trend adjusted admission rate for incentivised ACSCs and the trend adjusted admission rate for non-incentivised ACSCs or non-ACSCs.
The estimated reduction in admissions for incentivised ACSCs associated with the introduction of the Quality and Outcomes Framework scheme was 8% in the financial year 2010/11, equivalent to a reduction of approximately 53 000 emergency admissions across England.
34 35 36 37 Previous studies on the Quality and Outcomes Framework scheme have found associations between improved primary care management and reduced emergency admissions for chronic obstructive pulmonary disease, 38 coronary heart disease, 39 and stroke 40 but not for hypertension.
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