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Process indicators from same disease domain as removed indicator, selected to act as within condition controls in analyses (for example, influenza immunisation for asthma patients and smoking cessation advice for smokers with asthma).
§Process indicators from different disease domain for which process/action is similar or identical in removed indicator, selected to act as within process controls in analyses (for example, influenza immunisation in patients with asthma and patients with CHD).
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For five of the six removed indicators we analysed, we found no significant change in achievement rates following removal of the direct incentives, and the high levels of performance were maintained.
1 The central Quality and Management Analysis System database does not monitor performance for removed indicators.
Ten of the removed indicators related to the monitoring of particular aspects of patients' care; one indicator related to the treatment provided (influenza immunisation for adult patients with asthma).
12 It is possible that the effect of removing indicators is similarly complex with, for example, the effect of removing indicators where there is no associated financial incentive being different from removing one where there is an associated financial loss.
Understanding the effects of removing indicators has become a priority in the United Kingdom following a policy decision to remove indicators from the Quality and Outcomes Framework on a regular basis.
The number of indicators to take forward to the final round was decided by the study team through discussions with a GP, who provided independent clinical input when deciding on the optimal cutoff for removing indicators from each section.
The DSS approach permits model users to change the dependency networks, change the prioritization of data, and add or remove indicators and measures thus, it is flexible and dynamic.
Further processing of the clinical covariates was performed to remove indicators of allergic disease for the second clinical covariate single-domain clustering and Modk-prototype algorithm methods as described below.
There has been little work at an international level on this issue and we have developed and described a set of underpinning principles for indicator replacement and key issues that need to be considered by any organization or country planning to remove indicators from a clinical performance framework [ 15, 16].
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