MedWorm: Quality and Outcomes Framework

Does general practice reduce health inequalities? Analysis of quality and outcomes framework data

The European Journal of Public Health — Tue, 24 Jan 2012 05:00:00 +0100

Conclusion: The narrowing in performance between practices in Spearhead and non-Spearhead PCTs may have indirectly contributed to a reduction in area-based health inequalities but the differences are small. The lack of difference between the most deprived practices in Spearhead and non-Spearhead PCTs suggest that area-based initiatives to tackle inequalities have not yet had an observable impact on deprived practices. Unobserved factors explain most of the variation in achievement. (Source: The European Journal of Public Health)

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Social deprivation and prevalence of chronic kidney disease in the UK: workload implications for primary care

QJM — Mon, 16 Jan 2012 05:00:00 +0100

Conclusion: In the most deprived areas, there is an increased burden of major chronic disease and a higher caseload for clinicians. These reflect significant differences in workload for practices in deprived areas, which needs to be addressed. (Source: QJM)

Family Doctor Responses to Changes in Incentives for Influenza Immunization under the U.K. Quality and Outcomes Framework Pay‐for‐Performance Scheme

Health Services Research — Thu, 15 Dec 2011 05:00:00 +0100

ConclusionsMaking quality targets more demanding can not only lead to improvement in quality of care but can also have other consequences. (Source: Health Services Research)

Case identification of depression in patients with chronic physical health problems: a diagnostic accuracy meta-analysis of 113 studies.

The British Journal of General Practice — Thu, 01 Dec 2011 05:00:00 +0100

CONCLUSION: Assessing both validity and ease of use, the two stem questions are the preferred method. However, clinicians should not rely on the two-questions approach alone, but should be confident to engage in a more detailed clinical assessment of patients who score positively. PMID: 22137418 [PubMed - in process] (Source: The British Journal of General Practice)

Identifying unintended consequences of quality indicators: a qualitative study

Quality and Safety in Health Care — Wed, 23 Nov 2011 05:00:00 +0100

Conclusions It is important to identify concerns and experiences about unintended consequences of indicators at an early stage when there is time to remove or adapt problem indicators. Since the UK government currently spends over £1 billion each year on QOF, the £150 000 spent on each piloting cohort (0.0005% of the total QOF budget) appears to be good value for money. (Source: Quality and Safety in Health Care)

Quality and Outcomes Framework exception reporting 2010/11 published

NeLM - News — Wed, 16 Nov 2011 05:00:00 +0100

Source: The NHS Information Centre Area: News The NHS Information Centre has published a report of "exceptions" for the Quality and Outcomes Framework. The Quality and Outcomes Framework (QOF) allows practices to exception-report (exclude) specific patients from data collected to calculate achievement scores. Patients can be exception-reported from individual indicators for various reasons, for example if they are newly diagnosed or newly registered with a practice, if they do not attend appointments or where the treatment is judged to be inappropriate by the GP (such as medication cannot be prescribed due to side-effects). Data for 2010/11 showed that in 2010/11 the overall effective exception rate for England, across all clinical domain indicator groups, was 5.4 per cent (unc...

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Characteristics of general practices associated with emergency-department attendance rates: a cross-sectional study

Quality and Safety in Health Care — Tue, 25 Oct 2011 04:00:00 +0100

Conclusions Performance as indicated by the quality and outcomes framework did not predict rates of attendance at emergency departments, but satisfaction with telephone access did. Consideration should be given to improving access to some general practices to contain the use of emergency departments. (Source: Quality and Safety in Health Care)

Use of outcomes in monitoring healthcare - how many outcome measures are needed in monitoring diabetes in primary care?

JRSM — Mon, 03 Oct 2011 04:00:00 +0100

Conclusions Although patient experience at practice level should be included in monitoring outcomes, it should not replace monitoring clinical outcomes in diabetes. A mix of clinical and patient experience measures will have to be used to monitor outcomes in general practice. (Source: JRSM)

The effect of financial incentives on the quality of health care provided by primary care physicians.

Cochrane Database of Systematic Reviews — Fri, 16 Sep 2011 09:32:03 +0100

CONCLUSIONS: The use of financial incentives to reward PCPs for improving the quality of primary healthcare services is growing. However, there is insufficient evidence to support or not support the use of financial incentives to improve the quality of primary health care. Implementation should proceed with caution and incentive schemes should be more carefully designed before implementation. In addition to basing incentive design more on theory, there is a large literature discussing experiences with these schemes that can be used to draw out a number of lessons that can be learned and that could be used to influence or modify the design of incentive schemes. More rigorous study designs need to be used to account for the selection of physicians into incentive schemes. The use of instrumen...

UK Government's Targets System - GPs Seem Divided In Their Opinion

Health News from Medical News Today — Thu, 15 Sep 2011 16:00:00 +0100

In 2004 the UK government introduced the Quality and Outcomes Framework (QoF) to reward practices that meet certain targets, such as measuring cholesterol regularly in patients with heart disease, however according to new research from Cardiff University, GPs seem divided in their opinion about the reward system. The system involves reminders appearing on GPs computers that set out various tasks during consultation, while some GPs regard the reward system as a helpful innovation, others fear it is distracting them from concentrating on their patients... (Source: Health News from Medical News Today)

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Research paper: Does better primary care disease management reduce hospital costs?

NeLM - News — Mon, 12 Sep 2011 04:00:00 +0100

Source: King's Fund Area: News This research paper from the Centre of Health Economics, University of York, discusses how general practice disease management may affect hospital costs and describes the estimation methods used to detect these effects. The authors note that pay for performance schemes have been introduced in several countries in an attempt to improve the quality of disease management in primary care. The Quality and Outcomes Framework (QOF) incentive scheme in the UK, introduced as part of the new contract for the delivery of primary care, was associated with increased expenditure (from £5.8 billion in 2003/04 to £7.8 billion in 2005/06), with around 20% of GP income determined by achievement against quality indicators. The pu...

The equity dimension in evaluations of the Quality and Outcomes Framework : A systematic review.

BMC Health Services Research — Tue, 30 Aug 2011 23:00:00 +0100

Conclusions: Although QOF seems not to be socially selective at first glance, this does not mean QOF does not contribute to the inverse care law. Introducing different targets for specific patient groups and including appropriate, non-disease specific and patient-centred indicators that grasp the complexity of primary care might refine the equity dimension of the evaluation of QOF. Also, information on the actual uptake of care, information at the patient level and monitoring of individuals' health care utilisation tracks could make large contributions to an in-depth evaluation. Finally, evaluating pay-for-quality initiatives in a broader health systems impact assessment strategy with equity as a full assessment criterion is of utmost importance. (Source: BMC Health Services Research)

Letter - Medical professionalism and pay-for-performance.

The British Journal of General Practice — Thu, 18 Aug 2011 23:00:00 +0100

Authors: Chambers J, Tormey W Abstract In his Editor's Briefing, Roger Jones opines that the Quality and Outcomes Framework may lead to maladaptive behaviours and deprofessionalisation.1 This begs the question, what exactly constitutes medical professionalism? In 1977, Dr CF Donovan defined clinical competence as the first key responsibility of the doctor.2 A continuing commitment to excellence through the application of current knowledge, and the continuing acquisition of new knowledge are key attributes of medical professionalism.3 However, the population mortality reduction of 11 lives per 100 000 people as a consequence of the pay-for-performance contract in England, and the implication that a similar payment system improved blood pressure control in Scotland, suggests that the...

Commissioning specialist diabetes services for adults with diabetes: summary of a Diabetes UK Task and Finish Group report

Diabetic Medicine — Thu, 11 Aug 2011 23:00:00 +0100

AbstractThe increasing prevalence of diabetes, the drive to develop community services for diabetes and the Quality and Outcomes Framework for diabetes have led to improvements in the management of diabetes in primary care settings, with services traditionally provided only in specialist care now provided for many patients with diabetes by non‐specialists. Consequently, there been a need to redefine roles, responsibilities and components of a specialist diabetes service to provide for the needs of patients in the National Health Service (NHS) today. The delivery of diabetes care is complex and touches on almost every aspect of the health service. It is the responsibility of those working within commissioning and specialist provider roles to work together with people with diabetes to deve...

Framework and indicator testing protocol for developing and piloting quality indicators for the UK Quality and Outcomes Framework

BMC Family Practice — Tue, 09 Aug 2011 23:00:00 +0100

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Association of practice size and pay-for-performance incentives with the quality of diabetes management in primary care.

cmaj — Sun, 07 Aug 2011 23:00:00 +0100

We examined this association between 1997 and 2005, in addition to the impact of the Quality and Outcomes Framework, a pay-for-performance incentive scheme introduced in the United Kingdom in 2004, on diabetes management. METHODS: We conducted a retrospective opencohort study using data from the General Practice Research Database. We enrolled 422 general practices providing care for 154 945 patients with diabetes. Our primary outcome measures were the achievement of national treatment targets for blood pressure, glycated hemoglobin (HbA1c) levels and total cholesterol. RESULTS: We saw improvements in the recording of process of care measures, prescribing and achieving intermediate outcomes in all practice sizes during the study period. We saw improvement in reaching national targets after ...

A strategy for the implementation of a quality indicator system in German primary care.

Quality in Primary Care — Sat, 30 Jul 2011 08:30:04 +0100

Conclusion For the successful implementation of a quality indicator system in German primary care a number of key issues, as presented in this article, need to be taken into account. PMID: 21781434 [PubMed - in process] (Source: Quality in Primary Care)

Measuring depression severity in general practice: discriminatory performance of the PHQ-9, HADS-D, and BDI-II.

The British Journal of General Practice — Thu, 30 Jun 2011 23:00:00 +0100

Authors: Cameron IM, Cardy A, Crawford JR, du Toit SW, Hay S, Lawton K, Mitchell K, Sharma S, Shivaprasad S, Winning S, Reid IC The UK Quality and Outcomes Framework (QOF) rewards practices for measuring symptom severity in patients with depression, but the endorsed scales have not been comprehensively validated for this purpose. PMID: 21722450 [PubMed - in process] (Source: The British Journal of General Practice)

Impact of the GP contract on inequalities associated with influenza immunisation: a retrospective population-database analysis.

The British Journal of General Practice — Thu, 30 Jun 2011 23:00:00 +0100

Authors: Norbury M, Fawkes N, Guthrie B Influenza immunisation is recommended for all people aged ≥65 years and younger people with particular chronic diseases. The Quality and Outcomes Framework (QOF) has provided new financial incentives for influenza immunisation since 2004. PMID: 21722444 [PubMed - in process] (Source: The British Journal of General Practice)

GP Reward Scheme May Lead To "Unintended Consequences", Reveals A New Study, UK

Health News from Medical News Today — Thu, 30 Jun 2011 15:00:00 +0100

A study published on bmj.com today states that while the GP performance scheme in the UK has led to improvement in the quality of care; there have been small deleterious consequences on aspects of care that are non-incentivized. The results of this study raise concern that financial incentive schemes can have possible unforeseen consequences and my even cause neglect of non-incentivized elements of patient care. An incentive scheme termed Quality and Outcomes Framework (QOF) was formulated in 2004. This scheme, which receives an annual funding of Â£1bn (1.1bn; $1... (Source: Health News from Medical News Today)

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Effect of financial incentives on incentivised and non-incentivised clinical activities: longitudinal analysis of data from the UK Quality and Outcomes Framework

BMJ Online First — Mon, 27 Jun 2011 23:00:00 +0100

Objective To investigate whether the incentive scheme for UK general practitioners led them to neglect activities not included in the scheme. Design Longitudinal analysis of achievement rates for 42... (Source: BMJ Online First)

Highlights from this issue

Emergency Medicine Journal — Wed, 22 Jun 2011 23:00:00 +0100

Access to primary care and emergency admission rates It is ‘obvious’ that there is a link between primary, urgent and emergency care— after all, the patients who are seen in all three settings are often the same people. It is less obvious which particular characteristics of the patients, the practices and the hospitals affect the relationship. In a study based in Leicester, England, Bankart and colleagues have examined emergency admission rates—looking at both the known suspects (population deprivation, practice size, age, ethnicity, gender and distance) and the novel measures of access to primary care and practice quality. Their study confirms the previously recognised associations; more interestingly, they found no association between practice quality as reflected...

Characteristics of general practices associated with emergency admission rates to hospital: a cross-sectional study

Emergency Medicine Journal — Wed, 22 Jun 2011 23:00:00 +0100

Conclusions The patient characteristics of deprivation, age, ethnicity and gender are important predictors of admission rates. Larger practices and greater distance from a hospital have lower admission rates. Being able to consult a particular GP, an aspect of continuity, is associated with lower emergency admission rates. (Source: Emergency Medicine Journal)

Involving primary care and cardiac rehabilitation in a reorganised service could improve outcomes

Heart — Thu, 16 Jun 2011 23:00:00 +0100

To the Editor The full National Heart Failure Audit report1 and a recent editorial in the Lancet endorse the report's conclusion that it ‘provides a powerful incentive to reorganise heart failure care in the UK’.1 2 The suggested solution is to provide specialist care similar to that given to people after heart attacks citing that such specialised units ‘could do for heart failure what coronary care units have done for myocardial infarction’.2 There is no mention of how primary care could be involved and there is only a passing reference to rehabilitation. Since 2004, general practitioners in the UK have been rewarded for maintaining heart failure registers through the quality and outcomes framework of the General Medical Services contract. In many parts of the UK, ...

NICE recommends 20 QOF indicators for inclusion in 2012/13 QOF

NeLM - News — Thu, 16 Jun 2011 23:00:00 +0100

Source: E-Health Insider Area: News E-Health Insider (EHI) reports that the National Institute for Health and Clinical Excellence (NICE) is due to recommend 20 new indicators for possible inclusion in the 2012/13 Quality and Outcomes Framework (QOF). According to EHI, the decision to put forward the 20 indicators was made in the June meeting of NICE's Primary Care QOF Indicator Advisory Committee. The Committee has also suggested four existing indicators for retirement. The new potential indicators include (direct from source): . offering advice and support to smokers . referring patients with newly diagnosed diabetes to a structured education programme. . an incentive for GP practices to carry out an annual assessment of the physical activity of patients wit...

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Recording patient preferences for end-of-life care as an incentivized quality indicator: What do general practice staff think?

Palliative Medicine — Wed, 15 Jun 2011 23:00:00 +0100

CONCLUSIONS: The most appropriate time to ask a patient about end-of-life care is subjective and patient specific and therefore does not lend itself to an inflexible single indicator. Focusing on one isolated question simplifies and distracts from a multi-faceted and complex issue and may lead to patient harm. PMID: 21680749 [PubMed - as supplied by publisher] (Source: Palliative Medicine)

A comparison of patient recall of smoking cessation advice with advice recorded in electronic medical records

BMC Public Health - Latest articles — Mon, 09 May 2011 23:00:00 +0100

Conclusions Since the introduction of the QOF, the rate of recording of cessation advice in primary care medical records has exceeded that of patient recall. Whilst both data sources have limitations, our study suggests that, in recent years, the proportion of smokers being advised to quit by primary care health professionals may not have improved as much as the improved recording rates imply. (Source: BMC Public Health - Latest articles)

Impact of the QOF and the NICE guideline in the diagnosis and management of depression: a qualitative study

NeLM - Mental Health — Thu, 05 May 2011 23:00:00 +0100

Source: British Journal of General Practice Area: Evidence > Medicines Management > References Background: The National Institute for Health and clinical Excellence (NICE) depression guideline (2004) and the updated Quality and Outcomes Framework (QOF) ( 2006) in general practice have introduced the concepts of screening severity assessment, for example using the Patient Health Questionnaire 9 (PHQ-9), and `stepped care' for depression. Aim: To explore primary care practitioner perspectives on the clinical utility of the NICE guideline and the impact of the QOF on diagnosis and management of depression in routine practice. Design and setting: Qualitative study using focus groups from four multidisciplinary practice teams with diverse populations in south Yorkshire. ...

The Association of Public Health Observatories (APHO) Diabetes Prevalence Model: estimates of total diabetes prevalence for England, 2010-2030.

Molecular Medicine — Sat, 30 Apr 2011 23:00:00 +0100

Conclusions This model estimates that the prevalence of total diabetes (diagnosed and undiagnosed) in England is higher than previously suggested. An ageing population and increasing prevalence of obesity imply that the prevalence of diabetes will continue to rise and health services should be planned accordingly. PMID: 21480968 [PubMed - in process] (Source: Molecular Medicine)

Impact of the QOF and the NICE guideline in the diagnosis andmanagement of depression: a qualitative study.

The British Journal of General Practice — Sat, 30 Apr 2011 23:00:00 +0100

Authors: Mitchell C, Dwyer R, Hagan T, Mathers N The National Institute for Health and clinical Excellence (NICE) depression guideline (2004) and the updated Quality and Outcomes Framework (QOF) ( 2006) in general practice have introduced the concepts of screening severity assessment, for example using the Patient Health Questionnaire 9 (PHQ-9), and 'stepped care' for depression. PMID: 21619752 [PubMed - in process] (Source: The British Journal of General Practice)

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No Evidence That Financial Incentives For GPs Have Improved Health Or Reduced Inequalities, UK

Health News from Medical News Today — Tue, 26 Apr 2011 08:00:00 +0100

The pay-for-performance scheme for GPs introduced in April 2004, known as the Quality and Outcomes Framework (QOF), has not resulted in improved ill-health prevention or health promotion by general practitioners, reveals new research published last Thursday. Researchers looked at the impact of the QOF on public health and inequalities and revealed that where local practices were undertaking preventive activities, they usually pre-dated the QOF and were not a result of the incentives... (Source: Health News from Medical News Today)

Report highlights QOF flaws regarding public health

OnMedica Latest News — Fri, 22 Apr 2011 23:00:00 +0100

Quality and Outcomes Framework revisions called for to tackle health inequalitiesRelated items from OnMedicaMore money needed for nutritional care in NHSChlamydia programme wasted moneyGovernment announces swine flu reviewHealth Bill “is a massive gamble”Watchdog assessment finds upwards ‘shift in performance’ (Source: OnMedica Latest News)

King's Fund report: Impact of Quality and Outcomes Framework on health inequalities

NeLM - News — Wed, 20 Apr 2011 23:00:00 +0100

Source: King's Fund Area: News The National Institute for Health Research Service Delivery and Organisation programme commissioned the King's Fund, together with the London School of Hygiene & Tropical Medicine, to explore the impact of the Quality and Outcomes Framework (QOF) on public health and health inequalities. The research aimed to examine whether the GMS contract and, in particular, the QOF was contributing to improvements in public health and reductions in health inequalities; the focus was on health inequalities as determined by income deprivation. The following areas were addressed: . Incentives for prevention and public health activities . Differences in performance by deprivation . Impact on population health . Practice character...

New Medicines Management related indicators included in the Quality and Outcomes Framework for 2011/12

NeLM - News — Thu, 14 Apr 2011 23:00:00 +0100

Source: NHS Employers Area: News The Quality and Outcomes Framework (QoF) guidance negotiated for 2011/12 contains new indicators which will have implications for medicines management. In particular, the Quality and Productivity (QP) domain contains a new indicator set (QP 1-5) relating to prescribing. This indicator set requires that practices conduct an internal review of their prescribing followed by an external peer review which will include an assessment of clinical and cost effectiveness. Practices will be required to agree three areas in which to make improvements. The indicators are given below (direct from source): QP1: The practice conducts an internal review of their prescribing to assess whether it is clinically appropriate and cost effective, agrees with the PCO 3 areas for i...

Exception reporting in the Quality and Outcomes Framework: views of practice staff - a qualitative study.

The British Journal of General Practice — Thu, 31 Mar 2011 23:00:00 +0100

Authors: Campbell S, Hannon K, Lester H 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. PMID: 21439176 [PubMed - in process] (Source: The British Journal of General Practice)

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Views of cancer care reviews in primary care: a qualitative study.

The British Journal of General Practice — Thu, 31 Mar 2011 23:00:00 +0100

Authors: Adams E, Boulton M, Rose P, Lund S, Richardson A, Wilson S, Watson E The Quality and Outcomes Framework (QOF) provides an incentive for practices to establish a cancer register and conduct a review with cancer patients within 6 months of diagnosis, but implementation is unknown. PMID: 21439175 [PubMed - in process] (Source: The British Journal of General Practice)

Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care.

BMC Family Practice — Tue, 22 Mar 2011 00:00:00 +0100

Conclusion: Depression was often normalised in the presence of LTCs, obviating rather than facilitating further assessment and management. Furthermore, structural constraints imposed by the QOF encouraged reductionist approaches to case-finding for depression in consultations for CHD and diabetes. Future work might focus on how interventions that draw on the principles of the chronic care model, such as collaborative care, could support primary care practitioners to better recognise and manage depression in patients with LTCs. (Source: BMC Family Practice)

General Medical Services 2011/12 contract agreement published

NeLM - News — Mon, 14 Mar 2011 00:00:00 +0100

Source: NHS Networks Area: News NHS Employers and the General Practitioners Committee of the BMA have agreed changes to the General Medical Services contract for 2011/12 for England, Scotland and Wales. Please see link below for details of the changes, which include changes to the Quality and Outcomes Framework including the implementation of NICE recommendations and the inclusion of new quality and productivity indicators. (Source: NeLM - News)

GPs less likely to meet care home quality targets

Nursing Times Breaking News — Sat, 12 Mar 2011 00:00:00 +0100

The quality of chronic disease care under the GP performance related pay system – the quality and outcomes framework – is poorer for care homes residents than those living in the community, according to a BMJ study. (Source: Nursing Times Breaking News)

Quality of chronic disease care for older people in care homes and the community in a primary care pay for performance system: retrospective study

NeLM - Care of Older People — Wed, 09 Mar 2011 00:00:00 +0100

Source: British Medical Journal Area: Evidence > Medicines Management > References Objective: To describe the quality of care for chronic diseases among older people in care homes (nursing and residential) compared with the community in a pay for performance system. Design: Retrospective analysis of The Health Improvement Network (THIN), a large primary care database. Setting: 326 English and Welsh general practices, 2008-09. Participants: 10,387 residents of care homes and 403,259 residents in the community aged 65 to 104 and registered for 90 or more days with their general practitioner. Main Outcome Measure: 16 process quality indicators for chronic disease management appropriate for vulnerable older people for conditions included in the UK Quality and Outcomes Framework. Res...

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Commentary: UK’s P4P initiative has had ‘ambiguous’ impact on care

Health Imaging News — Mon, 07 Mar 2011 21:24:13 +0100

A commentary on the National Quality Measures Clearinghouse website titled “Pay for Performance in U.K. General Practice—The Ambiguous Impact of the Quality and Outcomes Framework,” offers a mixed review of the pay-for-performance (P4P) initiatives of the National Health Services' Quality and Outcomes Framework. (Source: Health Imaging News)

NICE Opens Consultation On Potential New QOF Indicators

Health News from Medical News Today — Tue, 01 Mar 2011 09:00:00 +0100

The National Institute for Health and Clinical Excellence (NICE) has opened its consultation on potential new clinical and health improvement indicators for the 2012/13 Quality and Outcomes Framework (QOF). Anyone with an interest in health is encouraged to submit their comments via the NICE website [1]. Individuals and stakeholders are asked to consider any implementation challenges, impact on health inequalities or possible unintended consequences for this new set of proposed indicators... (Source: Health News from Medical News Today)

Which factors are associated with higher rates of chronic kidney disease recording in primary care? A cross-sectional survey of GP practices.

The British Journal of General Practice — Tue, 01 Mar 2011 00:00:00 +0100

This study aimed to identify practice or patient characteristics associated with recorded rates of CKD. Demographic and QOF data for 230 general practices were combined into a database for cross-sectional analysis. Regression analyses investigated factors associated with CKD recording; deprivation, location in Leicester city or Northamptonshire, and low recording of hypertension and stroke were associated with low CKD recording. PMID: 21375906 [PubMed - in process] (Source: The British Journal of General Practice)

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NICE consults on potential new QOF indicators for 2012/13

NeLM - News — Mon, 28 Feb 2011 00:00:00 +0100

Source: NICE Area: News NICE is consulting on a number of potential new indicators for the 2012/13 Quality and Outcomes Framework (QOF); stakeholders are invited to comment by 5.30pm on Monday 28th March 2011 (please see the link below for details). The 29 potential new indicators cover the following domains: . Asthma . Peripheral Artery Disease . Smoking . Atrial Fibrillation . Diabetes . Primary prevention of CVD . Osteoporosis . Physical Activity . Obesity (Source: NeLM - News)

Health Foundation report: Do quality improvements in primary care reduce secondary care costs?

NeLM - News — Wed, 16 Feb 2011 00:00:00 +0100

Source: Health Foundation Area: News The Health Foundation has published a research report on whether the concept of Quality and Outcomes Framework (QOF) which was introduced into UK primary care in 2004, reduces health service costs or improved health outcomes. QOF was introduced to reward general practitioners (GPs) for a wide range of care processes and outcomes, with about 20% of their income tied to QOF financial incentives. Considerable effort was made to ensure that the QOF was aligned with best contemporary clinical practice (to the extent that evidence permitted). However, little work to date has examined whether it has led to reduced health service costs or improved health outcomes. The report addresses the following questions: . does improved performa...

Exclusion of patients from quality measurement of diabetes care in the UK pay‐for‐performance programme

Diabetic Medicine — Sat, 05 Feb 2011 00:00:00 +0100

Conclusions Patients excluded from pay‐for‐performance programmes may be less likely to achieve treatment goals and disproportionately come from disadvantaged groups. Permitting physicians to exclude patients from pay‐for‐performance programmes may worsen health disparities. (Source: Diabetic Medicine)

Call for new QOF topics for 2013/2014

NeLM - News — Tue, 01 Feb 2011 00:00:00 +0100

Source: NICE Area: News GPs and other health professionals, along with patients and charity groups, are being invited to suggest topics for new indicators for the 2013/14 Quality and Outcomes Framework (QOF). The online topic suggestion facility for proposals will be open until Monday 28 February. The first phase of topic suggestion for the 2013/14 QOF began back in September 2010. The Primary Care QOF Advisory Committee considered suitable suggestions in December 2010 and agreed to reword the chosen recommendations into indicators suitable for GP clinical systems, and to pilot a number of potential indicators in 30 representative practices across England, Wales, Scotland and Northern Ireland. This process will be repeated for topics prioritised by the committee fol...

Depression indicators in a national sample of older community and care home patients: applying the Quality and Outcomes Framework.

The British Journal of General Practice — Tue, 01 Feb 2011 00:00:00 +0100

Authors: Harris T, Shah SM, Carey IM, Dewilde S, Cook DG In a national primary care database sample of older people (≥65 years), 81% (83 588/103 821) of community and 58% (1702/2940) of care home residents with diabetes or heart disease had depression case finding recently recorded; 66% (1418/2145) of community and 22% (26/118) of care home residents with a new depression episode had a depression-severity assessment recorded. Age, sex, and higher care home dementia prevalence did not explain these differences. Case finding and assessment of depression need to be improved in older people, particularly care home residents. PMID: 21276341 [PubMed - in process] (Source: The British Journal of General Practice)

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BMA Comment On BMJ Research Into The Impact Of The Quality And Outcomes Framework On The Treatment Of High Blood Pressure, UK

Health News from Medical News Today — Wed, 26 Jan 2011 09:00:00 +0100

Commenting on research in the BMJ looking into the Quality and Outcomes Framework (QOF) and the treatment of people with high blood pressure, Dr Laurence Buckman, Chairman of the BMA's GPs Committee, said: "There is a mistaken belief that the Quality and Outcomes Framework is simply an incentive scheme, but it's much more than that... (Source: Health News from Medical News Today)

Pay for performance doesn't seem to improve quality of care in hypertension

NeLM - News — Wed, 26 Jan 2011 00:00:00 +0100

Source: BMJ Area: News Analysis of data from a large general practice database found no evidence that the UK GP pay for performance scheme had any significant effect either on quality of care in hypertension or relevant clinical outcomes. Pay for performance schemes have been widely used over the past decade in an attempt to improve quality and outcomes of care; there have, however, been few evaluations of such schemes. The UK Quality and Outcomes Framework (QOF) was implemented in 2004 and included hypertension as one of the conditions targeted. The authors of this study used data from The Health Improvement Network (THIN), a large database of primary care medical records, with about 6.2 million patient years from 358 general practices to investigate the effects of the QOF in ...

Analysis: devolving national pay for performance programmes

NeLM - News — Tue, 25 Jan 2011 00:00:00 +0100

Source: British Medical Journal (BMJ) Area: News The recommendation that part of the Quality and Outcomes Framework (QoF) be devolved to local areas, made in the NHS review 'High Quality Care For All', has not been widely implemented. In this article, the authors discuss how, in their experience, it can help focus attention on local health needs. (Source: NeLM - News)

Scrap exception reporting by GPs to protect population health

HSJ — Wed, 19 Jan 2011 12:20:00 +0100

Exception reporting, which allows GPs to exclude patients from their quality and outcomes framework assessment, must be abolished, writes Asthma UK chief executive Neil Churchill in this week’s HSJ. (Source: HSJ)

'Time to scrap GP exception reporting'

HSJ — Wed, 19 Jan 2011 12:19:00 +0100

We must now scrap exception reporting by GPs in the quality and outcomes framework. (Source: HSJ)

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Identifying poorly performing general practices in England: a longitudinal study using data from the quality and outcomes framework

Journal of Health Services Research and Policy — Fri, 24 Dec 2010 00:00:00 +0100

Conclusions A small minority of practices have remained poor performers in terms of measurable performance indicators over a four-year period. The strongest predictors of poor QOF performance were singlehanded and small practices, and practices staffed by elderly GPs. (Source: Journal of Health Services Research and Policy)

Emergency admissions for coronary heart disease: A cross-sectional study of general practice, population and hospital factors in England

Public Health — Fri, 24 Dec 2010 00:00:00 +0100

Conclusions: There is no clinically significant relationship between better quality of primary care, as measured by disease-specific QOF measures, and fewer CHD admissions. Deprivation, CHD prevalence and smoking are major risk factors for emergency admission for CHD. (Source: Public Health)

The Association of Public Health Observatories (APHO) Diabetes Prevalence Model: estimates of total diabetes prevalence for England, 2010–2030

Diabetic Medicine — Wed, 22 Dec 2010 00:00:00 +0100

Dentists set to be paid per head in bid to shift from “drill and fill”

OnMedica Latest News — Fri, 17 Dec 2010 00:00:00 +0100

Dental Quality and Outcomes Framework to be developedRelated items from OnMedicaNew plans announced to improve access to drugs BMA welcomes Darzi report'Ditch' private management consultants from the NHS'Invest more in consultants' urges BMA Scotland NHS faces 'most severe financial challenge' ever (Source: OnMedica Latest News)

Number Of People Diagnosed With Dementia In England Still Falling Short

Health News from Medical News Today — Wed, 15 Dec 2010 10:00:00 +0100

New NHS statistics highlighting the number of people diagnosed with dementia do not accurately reflect the real number of people with the condition, according to Alzheimer's Society. Figures released by the NHS (Quality and Outcomes Framework, QOF) show that almost 249,463 in England have been formally diagnosed with dementia which is a far cry from the true figure of 575,000 who have the condition... (Source: Health News from Medical News Today)

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GP incentive framework fails to slow admissions

HSJ — Thu, 25 Nov 2010 00:00:00 +0100

The £1bn quality and outcomes framework has failed to halt the rise in hospital admissions of people with long term conditions and needs to be overhauled, a think tank has claimed. (Source: HSJ)

The impact of an educational intervention, the New GP Contract and NICE guidelines on anti-epilepsy therapeutic drug monitoring

Seizure: European Journal of Epilepsy — Wed, 24 Nov 2010 00:00:00 +0100

Conclusion: The overall number of TDM requests has fallen since 2004 with the introduction of the New GP Contract and National Guidelines on the management of patients with epilepsy. The reduction has been more significant in areas where the changes were supplemented by an educational intervention. PCTs should endeavour to facilitate the introduction of National Guidelines with a supportive educational process, facilitated by educators with an interest and stake hold in those specific dillnesses. There is a significant cost to the NHS of inappropriate requests for TDM. Further study is required to quantify the indications for current requests for TDM. (Source: Seizure: European Journal of Epilepsy)

QoF performance drops slightly

EHI Primary Care — Thu, 21 Oct 2010 00:00:05 +0100

GP practices in England saw their performance on the Quality and Outcomes Framework fall slightly over the past 12 months, with the average practice earning almost 2% fewer points than in the previous year. (Source: EHI Primary Care)

DH tenders for QMAS replacement

EHI Primary Care — Mon, 18 Oct 2010 00:37:07 +0100

The Department of Health has published a tender for a GP Payments Calculation Service to calculate payments for the Quality and Outcomes Framework and payments to GPs for the performance of commissioning consortia. (Source: EHI Primary Care)

Surgeons work more effectively in private sector

OnMedica Latest News — Mon, 04 Oct 2010 23:00:00 +0100

Closed-shop 'NHS family' freezes out other providers to leave patients waiting Related items from OnMedica'Government targets intefere with war on superbugs'Government predicts 'end of waiting lists'Practices score more points under the quality and outcomes framework More leadership, less managementHospital transport service fails kidney patients (Source: OnMedica Latest News)

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Prescribing in type 2 diabetes: choices and challenges.

Nursing Standard — Fri, 01 Oct 2010 00:00:00 +0100

This article discusses the options for the prescriber when supporting those with type 2 diabetes to achieve target blood glucose levels. PMID: 21133019 [PubMed - in process] (Source: Nursing Standard)

QOF has narrowed health inequalities

Pulse — Fri, 10 Sep 2010 08:58:00 +0100

The Quality and Outcomes Framework has narrowed health inequalities by cutting admissions and deaths from heart disease most in deprived areas, new research shows. (Source: Pulse)

The association between quality of primary care, deprivation and cardiovascular outcomes: a cross-sectional study using data from the UK Quality and Outcomes Framework

Journal of Epidemiology and Community Health — Tue, 07 Sep 2010 08:21:44 +0100

Background The Quality and Outcomes Framework, a financial incentive scheme for general practitioners in the UK, seems to have improved the quality of primary care and reduced inequalities in primary care delivery. It remains unclear, however, whether higher-quality primary care improves health outcomes or reduces health inequalities. Methods We conducted a cross-sectional study examining the association between quality of cardiovascular care and coronary heart disease (CHD) outcomes in 1531 general practices in London. We calculated CHD quality achievement scores (ranging from 0 to 100) for each practice using the 2006–2007 data from the Quality and Outcomes Framework. We used weighted linear regression models to assess the practice-level association between the CHD quality score a...

The quality and outcomes framework reduces disparities in health outcomes for cardiovascular disease

Journal of Epidemiology and Community Health — Tue, 07 Sep 2010 08:21:43 +0100

(Source: Journal of Epidemiology and Community Health)

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UK GP pay-for-performance programme effect on mortality limited by inadequate targets?

NeLM - News — Mon, 06 Sep 2010 23:00:00 +0100

Source: Br J Gen Pract Area: News A modelling study of the potential health gains from the UK primary care payment for performance programme (Quality and Outcomes Framework, QOF) suggests that it may have reduced population overall mortality initially, but produced no effective gains subsequently as targets were set below the existing baseline. The QOF was introduced into UK primary care in 2004 with the aim of improving quality in four areas of practice, including clinical. It rewarded performance against set criteria, and in the clinical domains concentrated on treatment of common chronic conditions. There is debate over the most appropriate selection and use of indicators: this study was carried out to examine whether estimates of population health gain could be used to guid...

Quality and Outcomes Framework: time to take stock.

The British Journal of General Practice — Tue, 31 Aug 2010 23:00:00 +0100

Authors: Ashworth M, Kordowicz M PMID: 20849690 [PubMed - in process] (Source: The British Journal of General Practice)

Performance of small general practices under the UK's Quality and Outcomes Framework.

The British Journal of General Practice — Tue, 31 Aug 2010 23:00:00 +0100

CONCLUSION: Small practices were represented among both the best and the worst practices in terms of achievement of clinical quality targets. The effect of the pay-for-performance scheme appears to have been to reduce variation in performance, and to reduce the difference between large and small practices. PMID: 20849683 [PubMed - in process] (Source: The British Journal of General Practice)

Patient experience of access to primary care: identification of predictors in a national patient survey

BioMed Central — Fri, 27 Aug 2010 23:00:00 +0100

Conclusions: This study identifies a number of patient groups with lower satisfaction, and poorer experience, of gaining access to primary care. The finding that access is better in small practices is important given the increasing tendency for small practices to combine into larger units. Consideration needs to be given to ways of retaining these and other benefits of small practice size when primary care services are reconfigured. Differences between population groups (e.g. younger people, ethnic minorities) may be due to differences in actual care received or different response tendencies of different groups. Further analysis is needed to determine whether case-mix adjustment is required when comparing practices serving different populations. (Source: BioMed Central)

NICE opens floor to QOF ideas

HealthcareRepublic Independent Nurse News — Tue, 24 Aug 2010 00:20:00 +0100

NICE has invited stakeholders to submit suggestions for new indicators for the 2013/14 quality and outcomes framework (QOF). (Source: HealthcareRepublic Independent Nurse News)

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NICE invites new QOF indicator submissions

Pulse — Mon, 23 Aug 2010 16:46:00 +0100

NICE is calling for new suggestions for indicators for the 2013/14 Quality and Outcomes Framework. (Source: Pulse)

Eleven QoF indicators up for retirement

EHI Primary Care — Tue, 10 Aug 2010 09:29:22 +0100

Eleven indicators are likely to be retired from the Quality and Outcomes Framework next year if recommendations from the National Institute for Health and Clinical Excellence are implemented. (Source: EHI Primary Care)

NICE mulls change to QOF blood pressure targets

Pulse — Fri, 06 Aug 2010 08:30:00 +0100

Blood pressure targets in the quality and outcomes framework could be set to change as NICE seeks to align the targets with its own guidance, Pulse can reveal. (Source: Pulse)

GPs overlook public health for QOF cash

HSJ — Thu, 05 Aug 2010 00:00:00 +0100

The quality and outcomes framework has resulted in GPs focusing too narrowly on certain conditions to the detriment of their wider public health role, the King’s Fund has warned. (Source: HSJ)

NICE announces 2011-12 QOF indicators

NeLM - News — Wed, 04 Aug 2010 23:00:00 +0100

Source: NICE Area: News NICE has announced a menu of potential indicators for the 2011-12 Quality and Outcomes Framework (QOF) including: . Diabetes - two new indicators on foot examination to improve diabetes-related foot care and to improve patients' outcomes. . Dementia - a new indicator to identify people with a treatable cause of dementia. . Mental Health - six new indicators to improve care for patients with schizophrenia, bipolar affective disorder and other pyschoses. NICE has also made recommendations on indicators to be considered for retirement. These include current indicators on mental health, epilepsy and coronary heart disease. NHS Employers and the General Practitioners Committee of the British Medical Association ...

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NICE reveals suggestions for QOF changes

HealthcareRepublic Independent Nurse News — Tue, 03 Aug 2010 00:20:00 +0100

NICE has released its menu of indicators for the 2011/12 Quality and Outcomes Framework (QOF), covering BP, dementia, diabetes and mental illness. (Source: HealthcareRepublic Independent Nurse News)

Reductions in risk factors for secondary prevention of coronary heart disease by ethnic group in south-west London: 10-year longitudinal study (1998-2007)

Family Practice — Wed, 21 Jul 2010 00:54:43 +0100

Conclusions. From 1998 to 2007, risk factor control among patients with CHD improved, with reductions in their mean blood pressure and cholesterol across all ethnic groups. Widespread policy change has helped to improve the quality and equity of primary care for heart disease patients. Health improvements predated implementation of the Quality and Outcomes Framework and have since continued. Our findings illustrate how a national health care system with universal coverage can significantly reduce inequalities and improve chronic disease care for all ethnic groups. (Source: Family Practice)

Exclusive: Quality framework changes 'very difficult', warns NICE advisor

HealthcareRepublic Independent Nurse News — Wed, 07 Jul 2010 00:20:00 +0100

DoH plans to shift the focus of the Quality and Outcomes Framework (QOF) from processes to patient outcomes will prove 'very difficult' to achieve, a senior NICE advisor has warned. (Source: HealthcareRepublic Independent Nurse News)

Primary Medical Care Provider Accreditation (PMCPA): pilot evaluation.

The British Journal of General Practice — Wed, 30 Jun 2010 23:00:00 +0100

CONCLUSION: Version 1 of PMCPA has been piloted as a primary care accreditation scheme and shown to be relevant to different types of practice. The scheme is undergoing revision in accordance with the findings from the pilot and ongoing consultation. PMID: 20594431 [PubMed - as supplied by publisher] (Source: The British Journal of General Practice)

Impact of pay for performance on inequalities in health care: systematic review

Journal of Health Services Research and Policy — Wed, 16 Jun 2010 23:47:47 +0100

Conclusion Inequalities in chronic disease management have largely persisted after the introduction of the Quality and Outcome Framework. Pay for performance programmes should be designed to reduce inequalities as well as improve the overall quality of care. (Source: Journal of Health Services Research and Policy)

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The impact of the Quality and Outcomes Framework on practice organisation and service delivery: summary of evidence from two qualitative studies.

Quality in Primary Care — Fri, 11 Jun 2010 08:15:03 +0100

CONCLUSION: A number of significant changes to practice organisation and service delivery were observed, including: changes to practice organisational structures; an increased role for information technology; a move towards a more biomedical form of medical care; and changes to roles and relationships, including the introduction of internal peer-review and surveillance. In spite of this, the practices maintained a narrative of 'no change', arguing that they had 'fitted QOF in' to their routines with little trouble. PMID: 20529476 [PubMed - in process] (Source: Quality in Primary Care)

A review of the public health impact of the Quality and Outcomes Framework.

Quality in Primary Care — Fri, 11 Jun 2010 08:15:03 +0100

Authors: Dixon A, Khachatryan A There are clear policy objectives in England to encourage primary care and general practice to address health inequalities. In this paper we explore the potential impact of the Quality and Outcomes Framework (QOF) on health inequalities and review the available evidence including analysis of the area based differences in performance between practices in Spearhead and non-Spearhead areas. Overall, the evidence suggests that differences in performance, as measured by the QOF, between practices in deprived and non-deprived areas are narrowing. Although QOF achievement improved in all practices there is weak evidence as to the impact of the QOF on health. The evidence is equivocal as to whether improvements in clinical care and the narrowing gap in performan...

Quality and Outcomes Framework: smoke and mirrors?

Quality in Primary Care — Fri, 11 Jun 2010 08:15:03 +0100

Authors: Ashworth M, Kordowicz M Since its inception in 2004 the Quality and Outcomes Framework (QOF) has become embedded in the fabric of day-to-day general practice. Yet despite some of its tangible successes, the QOF's vulnerability to gaming poses challenges to its applicability as the dominant quality improvement framework in primary care. This paper questions whether high QOF scores amount to better care or simply the illusory effects of better data recording. Suggestions for developing QOF are made in the light of its limitations as a public health improvement initiative. PMID: 20529474 [PubMed - in process] (Source: Quality in Primary Care)

Research learning from the UK Quality and Outcomes Framework: a review of existing research.

Quality in Primary Care — Fri, 11 Jun 2010 08:15:03 +0100

CONCLUSION: The evidence base about the impact of the QOF is growing, but remains patchy and inconclusive. More high quality research is needed to inform decisions about how the framework should change to maximise improvements in health and equity. PMID: 20529473 [PubMed - in process] (Source: Quality in Primary Care)

Pay for performance schemes in primary care: what have we learnt?

Quality in Primary Care — Fri, 11 Jun 2010 08:15:03 +0100

CONCLUSION: P4P schemes need to take more account of broader definitions of quality, as whilst they can have a positive impact on incentivised clinical processes, it is not clear that this translates into improving the experience and outcome of care. PMID: 20529472 [PubMed - in process] (Source: Quality in Primary Care)

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Developing Quality and Outcomes Framework (QOF) indicators and the concept of 'QOFability'.

Quality in Primary Care — Fri, 11 Jun 2010 08:15:03 +0100

Authors: Lester H, Campbell S This paper explains the reasons and context behind the introduction of the Quality and Outcomes Framework (QOF) in the UK in April 2004. The QOF is a pay-for-performance scheme covering a range of clinical and organisational areas in primary care. In 2004, 52% of the framework related to clinical care, increasing to 66% in 2006 and 70% in 2009. From April 2009, the National Institute for Health and Clinical Excellence (NICE) has led a new process for developing the clinical QOF indicators. Clinical areas are now prioritised by an advisory committee appointed by NICE; the QOF indicators then undergo a formal consensus procedure followed by piloting in representative practices across England. However, what are the attributes of a good QOF indicator and how d...

Use of interval based quality indicators in blood pressure management to enhance quality of pay for performance incentives: comparison to two indicators from the Quality and Outcomes Framework.

Quality in Primary Care — Fri, 11 Jun 2010 08:15:03 +0100

CONCLUSION: Considering only a point-in-time controlled BP measurement provides an incomplete view of the quality of BP management in patients with hypertension or diabetes over a period of time. PMID: 20529470 [PubMed - in process] (Source: Quality in Primary Care)

Views of German general practitioners on the clinical indicators of the British Quality and Outcomes Framework: a qualitative study.

Quality in Primary Care — Fri, 11 Jun 2010 08:15:03 +0100

CONCLUSIONS: Participating German GPs had various concerns regarding the QOF clinical indicators and the idea of implementing a system like the QOF in German primary care. These concerns were mainly related to the validity of the indicators, the link between pay and performance, structured care versus patient centredness and the fear of external influences. PMID: 20529469 [PubMed - in process] (Source: Quality in Primary Care)

The Quality and Outcomes Framework: triumph of technical rationality, challenge for individual care?

Quality in Primary Care — Fri, 11 Jun 2010 08:15:03 +0100

Authors: Gillam S, Siriwardena AN PMID: 20529468 [PubMed - in process] (Source: Quality in Primary Care)

BMJ Head to Head: Should the Quality and Outcomes Framework be abolished?

NeLM - News — Mon, 07 Jun 2010 23:00:00 +0100

Source: BMJ Area: News The question being addressed in the latest BMJ Head to Head article is whether the Quality and Outcomes Framework should be abolished? A GP from Luton argues that it is not good value for money, arguing that the £1bn a year that the scheme costs has produced only modest improvements in measured quality of care and slight reductions in disparities between socioeconomic groups. He adds that in many instances, "the improvements in clinical indicators were in line with increases that might have been predicted on the basis of secular trends before the framework was introduced." He questions the extent to which these improvements are the result of better recording and notes that "commercially constructed evidence is driving up prescription rates for antidepres...

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Should the Quality and Outcomes Framework be abolished? Yes

BMJ Online First — Mon, 07 Jun 2010 10:43:21 +0100

(Source: BMJ Online First)

Should the Quality and Outcomes Framework be abolished? No

BMJ Online First — Mon, 07 Jun 2010 10:43:21 +0100

(Source: BMJ Online First)

Concordance between PHQ-9 scores and patients' experiences of depression: a mixed methods study.

The British Journal of General Practice — Mon, 31 May 2010 23:00:00 +0100

CONCLUSION: The potential therapeutic value of the PHQ-9 may be dependent upon the GP's willingness to openly discuss the results and what they may mean for the patient. PMID: 20529486 [PubMed - in process] (Source: The British Journal of General Practice)

Value for money and the Quality and Outcomes Framework in primary care in the UK NHS.

The British Journal of General Practice — Fri, 30 Apr 2010 17:44:07 +0100

CONCLUSION: For most indicators that can be assessed, QOF incentive payments are likely to be a cost-effective use of resources for a high proportion of primary care practices, even if the QOF achieves only modest improvements in care. However, only a small subset of the indicators has been considered, and no account has been taken of the costs of administering the QOF scheme. PMID: 20423576 [PubMed - in process] (Source: The British Journal of General Practice)

Value for money and the Quality and Outcomes Framework in primary care in the UK NHS

NeLM - News — Mon, 26 Apr 2010 23:00:00 +0100

Source: British Journal of General Practice Area: News According to a study published in the British Journal of General Practice, for most indicators that can be assessed, the Quality and Outcome Framework (QOF) incentive payments are likely to be a cost-effective use of resources for a high proportion of primary care practices, even if the QOF achieves only modest improvements in care. The Quality and Outcomes Framework (QOF) is a pioneering attempt to improve the quality of primary care in the UK through the use of financial rewards. Despite its achievements, there are concerns that the QOF may offer poor value for money. Researchers evaluated the cost-effectiveness of QOF payments, by identifying cost-effectiveness evidence for a subset of 9 QOF indicators, and th...

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Insulin initiation in primary care for patients with type 2 diabetes: 3-Year follow-up study

Primary Care Diabetes — Tue, 13 Apr 2010 23:00:00 +0100

Abstract: Purpose of study: To evaluate the 3-year impact of initiating basal insulin on glycaemic control (HbA1c) and weight gain in patients with poorly controlled type 2 diabetes registered with UK general practices that volunteered to participate in an insulin initiation training programme.Methods: Audit utilising data collected from practice record systems, which included data at baseline, 3, 6 months and subsequent six-monthly intervals post-insulin initiation for up to 10 patients per participating practice.Results: Of 115 eligible practices, 55 (47.8%) contributed data on a total of 516 patients. The mean improvement in HbA1c levels in the first 6 months was 1.4% (range −3.8% to 8.2%, median=1.40%). Thereafter, there was no overall change in HbA1c levels, although the change for ...

BMJ Analysis: How to identify when a performance indicator has run its course

NeLM - News — Thu, 08 Apr 2010 23:00:00 +0100

Source: BMJ Area: News The authors of this article discuss the removal of eight clinical indicators (worth 28 points) from the UK Quality and Outcomes Framework in April 2011. The eight indicators are all process measures and reward actions such as taking blood pressure or taking blood to measure cholesterol, glucose, or creatinine concentrations for people with relevant chronic diseases. The authors explain why the indicators were chosen and suggest a rationale for future decisions. (Source: NeLM - News)

British Medical Association Publishes Fifty Point Plan For General Practice

Health News from Medical News Today — Mon, 05 Apr 2010 08:00:00 +0100

The BMA's GPs Committee (GPC) published a fifty point plan for the future of general practice in the UK. Fit for the Future - the evolution of general practice makes recommendations for improvements in a number of areas including: Out-of-hours care, the Quality and Outcomes Framework (QOF), workforce, and Information Technology. General practice is recognised throughout the world as being one of the most cost-effective, high-quality means of delivering patient care... (Source: Health News from Medical News Today)

Has pay for performance improved the management of diabetes in the United Kingdom?

Primary Care Diabetes — Sun, 04 Apr 2010 23:00:00 +0100

Abstract: Over the past decade the UK government has introduced a number of major policy initiatives to improve the quality of health care. One such initiative was the introduction of the Quality and Outcomes Framework (QOF), a pay for performance scheme launched in April 2004, which aims to improve the primary care management of common chronic conditions including diabetes. Some evidence suggest that introduction of QOF has been associated with improvements in the quality indicators for diabetes care included in the framework. However, it is difficult to disentangle the impact of QOF from other quality initiatives as few studies adjusted for underlying trends in quality. There is some evidence that QOF may have reduced inequalities in diabetes care between affluent and deprived areas but ...

Do financial incentives for delivering health promotion counselling work? Analysis of smoking cessation activities stimulated by the quality and outcomes framework

BMC Public Health - Latest articles — Fri, 26 Mar 2010 00:00:00 +0100

DiscussionFinancial incentives undoubtedly influence GPs' activities, however, those aimed at encouraging GPs' delivery of health promotion counselling may not always have the effects intended. There is strong, observational evidence that targets and incentives intended to increase smoking cessation counselling by GPs have merely increased their propensity to record this activity in patients' medical records. The limitations of using financial incentives to stimulate the delivery of counselling in primary care are discussed and a re-appraisal of their use within UK GPs' performance-related pay system is argued for.SummaryThe utility of targets employed by the system for UK General Practitioners' performance related pay may be inappropriate for encouraging the delivery of health promotion c...

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NICE seeks feedback on new QOF indicators

Pulse — Thu, 18 Mar 2010 13:32:00 +0100

NICE has asked GPs to comment on six proposed new indicators for the 2011/12 quality and outcomes framework. (Source: Pulse)

NICE Invites Stakeholders To Comment On 2011/12 Quality Outcomes Framework

Health News from Medical News Today — Tue, 16 Mar 2010 07:00:00 +0100

The National Institute for Health and Clinical Excellence (NICE) has opened its consultation on potential new indicators for inclusion in the 2011/12 Quality and Outcomes Framework (QOF). Stakeholders are invited to email their comments on a set of potential indicators via the NICE website (http://www.nice.org.uk). Anyone with an interest in health, including health professionals, patients, community groups and voluntary organisations, is encouraged to take part in the consultation... (Source: Health News from Medical News Today)

Improvements in glycaemic control and cholesterol concentrations associated with the Quality and Outcomes Framework: a regional 2-year audit of diabetes care in the UK

Diabetic Medicine — Mon, 01 Mar 2010 00:00:00 +0100

Conclusion Since the introduction of performance indicators for primary care and the incorporation of pay for performance in 2004, there has been marked improvement in the management of hyperglycaemia and hypercholesterolaemia among people with diabetes with data available in 2006 and 2008. It remains to be seen whether the new HbA1c audit target (HbA1c < 7.0%) introduced in 2009 will result in a further improvement in glycaemic control. (Source: Diabetic Medicine)

Evidence-based commissioning: using population impact measures to help primary care trusts estimate the benefit of interventions in diabetes and heart failure

Quality and Safety in Health Care — Fri, 19 Feb 2010 09:11:10 +0100

Conclusions Local data and published literature estimates can be successfully combined to produce the number of events prevented within a locally defined PCT population (NEPP). Commissioners have shown interest in the utility of such a measure in identifying and quantifying areas for improvement. (Source: Quality and Safety in Health Care)

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Quality In General Practice: Improving Care For Patients, Scotland

Health News from Medical News Today — Wed, 10 Feb 2010 15:00:00 +0100

GPs are delivering dramatic improvements to the care and treatment of patients with long term conditions, reducing hospital admissions and saving lives, according to a new briefing paper published by BMA Scotland on Monday. The BMA Scotland briefing, The Quality and Outcomes Framework: delivering care; improving patient outcomes, considers the impact that the Quality Framework (QOF) of the 2004 general medical services contract is having on patient care... (Source: Health News from Medical News Today)

QOF has made "dramatic improvements" to patient care

Management in Practice — Tue, 09 Feb 2010 17:02:23 +0100

The Quality and Outcomes Framework is helping reduce health inequalities and should remain central to general practice, says the BMAS (Source: Management in Practice)

NICE Welcomes Topic Suggestions For QOF

Health News from Medical News Today — Tue, 09 Feb 2010 11:00:00 +0100

The National Institute for Health and Clinical Excellence (NICE) has opened the second and final phase of topic suggestion for the 2012/13 Quality and Outcomes Framework (QOF). An online topic suggestion facility will allow stakeholders to submit suggestions for new indicators for QOF based on NICE guidance or other NHS Evidence accredited sources. Anyone with an interest in health, including health professionals, patients, community groups and voluntary organisations are encouraged to contribute to the development of the 2012/13 framework via the NICE website... (Source: Health News from Medical News Today)

Sulphonyurea as a cause of severe hypoglycaemia in the community

Primary Care Diabetes — Mon, 11 Jan 2010 00:00:00 +0100

Conclusions: All patients taking SU and insulin treatment are potentially at risk of developing hypoglycaemia. Our, analysis shows that almost 15% of patients in our region who suffered from severe hypoglycaemia, were on SU therapy. Patients in this group were older and had lower levels of HbA1c. Whilst national HbA1c targets may be useful for clinicians to define glycaemic targets for their, population, this has to be tempered by what is in the best interests of the patient and not what is, dictated by the Quality and Outcomes Framework. Possible alternatives to SU therapy should be, considered especially if hypoglycaemia is a concern. (Source: Primary Care Diabetes)

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Is use of lower-price statins linked to poorer cholesterol control?

NeLM - Cardiovascular Medicine — Wed, 06 Jan 2010 00:00:00 +0100

Source: British Journal of General Practice Area: News A study published in the BJGP suggests that practices that have a greater proportion of low-cost statin prescribing may have poorer control of cholesterol levels. The author comments that UK GPs are under pressure to use mainly lower-cost statins for cholesterol control, and suggests that this may lead to poorer outcomes. He uses published administrative data to investigate whether high proportions of low-cost statin prescribing are associated with differences in outcome measures. The outcome data used come from the NHS QOF (Quality and Outcomes Framework): amongst other measures, this reports the proportions of patients with histories of cardiovascular disease and stroke who have total cholesterol levels below 5mmol/l. Dat...

Nurse staffing and quality of care in UK general practice: cross-sectional study using routinely collected data.

The British Journal of General Practice — Fri, 01 Jan 2010 00:00:00 +0100

CONCLUSION: Practices that employ more nurses perform better in a number of clinical domains measured by the QOF. This improved performance includes better intermediate clinical outcomes, suggesting real patient benefit may be associated with using nurses to deliver care to meet QOF targets. PMID: 20040166 [PubMed - in process] (Source: The British Journal of General Practice)

How do we compare? Applying UK pay for performance indicators to an Australian general practice.

Australian Family Physician — Fri, 01 Jan 2010 00:00:00 +0100

DISCUSSION: United Kingdom QOF clinical data is obtainable relatively easily in a well computerised Australian rural general practice. The exercise identified significant areas in which clinical performance could be improved. PMID: 20369134 [PubMed - in process] (Source: Australian Family Physician)

NICE approves trials of QOF indicators for PAD and asthma

Pulse — Fri, 11 Dec 2009 11:09:00 +0100

Indicators for peripheral arterial disease will be piloted with a view to including them in the quality and outcomes framework, the committee appointed by NICE to approve new indicators has decided. (Source: Pulse)

QoF reform in five year plan

EHI Primary Care — Fri, 11 Dec 2009 00:00:05 +0100

The Department of Health has promised to introduce a "significant reform" of the Quality and Outcomes Framework from 2011 as part of its five year plan for the NHS. (Source: EHI Primary Care)

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NHS Employers and General Practitioners Committee publish updated FAQs on chronic kidney disease

NeLM - News — Thu, 10 Dec 2009 00:00:00 +0100

Source: NHS Employers Area: News NHS Employers and the General Practitioners Committee have published updated frequently asked questions (FAQs) on diagnosing and managing chronic kidney disease (CKD), last published in 2007. The FAQs now include the latest available evidence and subsequent changes to the relevant indicators in the Quality and Outcomes Framework (QOF). (Source: NeLM - News)

Care home standards still give cause for concern

OnMedica Latest News — Thu, 03 Dec 2009 00:00:00 +0100

Despite improvements, some basic standards not being met; regulator warns it will get toughRelated items from OnMedicaElderly patients often receive undignified care 'Government targets intefere with war on superbugs'Government predicts 'end of waiting lists'Practices score more points under the quality and outcomes framework More leadership, less management (Source: OnMedica Latest News)

Improvements in glycaemic control and cholesterol concentrations associated with the Quality and Outcomes Framework: a regional 2 year audit of diabetes care in the UK

Diabetic Medicine — Tue, 01 Dec 2009 00:00:00 +0100

(Source: Diabetic Medicine)

A comparison of chronic illness care quality in US and UK family medicine practices prior to pay-for-performance initiatives

Family Practice — Tue, 17 Nov 2009 22:37:22 +0100

Conclusions. Following National Health Service (NHS) investment in primary care preparedness, but prior to the QOF, UK practices provided more standardized care but did not achieve better intermediate outcomes than a sample of typical US practices. US policymakers should focus on reducing variation in care documentation to ensure the effectiveness of P4P efforts while the NHS should focus on moving from process documentation to better patient outcomes. (Source: Family Practice)

Going upstream: the implication and opportunities of early detection

Journal of Renal Care — Tue, 03 Nov 2009 00:00:00 +0100

Chronic kidney disease (CKD) is common, harmful and treatable but has, until recently not been recognised in its early stages. The British National Health Service (NHS) provides a unique opportunity to study CKD because it is in effect a closed-managed care system. This single healthcare system for the United Kingdom is funded by the Government and paid for by general taxation. All UK citizens are registered with primary care physicians who control access to secondary care services. As a managed care system it should be able to offer integrated care across the whole patient pathway[mdash]allowing early identification of CKD, interventions to reduce risk and prompt management of complications. In reality, there are professional, organisational and institutional barriers to coordination and ...

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Statin prescribing in Northern Ireland and England pre and post introduction of the quality and outcomes framework

Pharmacy World & Science — Fri, 30 Oct 2009 18:32:10 +0100

Conclusion Strategies should be considered to educate prescribers on cost-effectiveness by increasing their awareness of the negative budgetary impact resulting from early adoption of new and expensive statins and by encouraging generic prescribing. Content Type Journal ArticleCategory Research ArticleDOI 10.1007/s11096-009-9339-3Authors Ibrahim Alabbadi, University of Jordan Biopharmaceutics and Clinical Pharmacy Department, Faculty of Pharmacy Amman JordanGrainne Crealey, The Royal Hospitals Clinical Research Support Centre, Education and Research Centre Grosvenor Road Belfast BT12 6BA UKKathryn Turner, Professional Pharmacy Services, Central Services Agency 2 Franklin Street Belfast BT2 8DQ UKTherese Rafferty, Central Services Agency 2 Franklin Street Belfast BT2 8DQ UKLynn Keenan...

Quality and outcomes framework exception reporting

PCCAS: Full newsfeed — Fri, 30 Oct 2009 16:26:34 +0100

The NHS Information Centre has published 'Quality and... (Source: PCCAS: Full newsfeed)

DH seeks views on replacement for QMAS

EHI Primary Care — Thu, 22 Oct 2009 12:15:00 +0100

The Department of Health is considering replacing the Quality, Management and Analysis System used for calculating Quality and Outcomes Framework payments. (Source: EHI Primary Care)

DH consultation for replacement of QMAS

NeLM - News — Wed, 21 Oct 2009 23:00:00 +0100

Source: E-Health Insider Area: News The Department of Health (DH) and NHS Connecting for Health are considering replacing the Quality, Management and Analysis System (QMAS) used for calculating Quality and Outcomes Framework (QoF) payments with a more flexible calculating and reporting system that will extend the payment system beyond QoF. The new system will be expected to collect information on the following: . national QOF . Quality indicators recommended by NICE that are not negotiated into the national QOF . Most Directed Enhanced Services (DESs) . Local Enhanced Services (LESs) that work in the same way as the other payments that are supported by the new system. Both bodies have launched a consultation to collect stakeholders' views includin...

Referral patterns to renal services: what has changed in the past 4 years?

Nephrology Dialysis Transplantation — Thu, 15 Oct 2009 08:26:23 +0100

Conclusion. Referral patterns have changed between 1 April 2004 and 31 March 2008. The main findings were an increase in referral rate and in the age at referral without a significant change in reported comorbidity of the people referred. The main increase in referral rates was seen in more advanced CKD suggesting more targeted referral of patients with CKD to renal services. (Source: Nephrology Dialysis Transplantation)

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NHS Information Centre bulletin on Quality and Outcomes Framework 2008/09

NeLM - News — Wed, 30 Sep 2009 23:00:00 +0100

Source: NHS Information Centre Area: News Information on the Quality and Outcomes Framework 2008/09 is available in a bulletin from the NHS Information Centre. Information was derived from the Quality Management Analysis System, a national system developed by NHS Connecting for Health, which uses data from general practices to calculate individual practices' QOF achievement. (Source: NeLM - News)

Which practices are high antibiotic prescribers? A cross-sectional analysis.

The British Journal of General Practice — Wed, 30 Sep 2009 23:00:00 +0100

CONCLUSION: Practice and practice population characteristics explained about one-sixth of the variation in antibiotic prescribing nationally. Consultation-level and qualitative studies are needed to help further explain these findings and improve our understanding of this variation. PMID: 19843411 [PubMed - in process] (Source: The British Journal of General Practice)

GPs increase QOF depression scores despite rise in prevalence

Management in Practice — Wed, 30 Sep 2009 18:51:38 +0100

Depression is the most difficult condition for which GPs in England can score points under the Quality and Outcomes Framework (QOF) (Source: Management in Practice)

QoF income falls trigger survey row

EHI Primary Care — Wed, 30 Sep 2009 00:00:05 +0100

GP practices' achievement on the Quality and Outcomes Framework fell across the UK in the last financial year, costing the average practice in England about £1,800. (Source: EHI Primary Care)

GMC issues confidentiality guidance

EHI Primary Care — Tue, 29 Sep 2009 00:00:05 +0100

Fresh guidance on confidentiality has been published by the General Medical Council, with advice on topics including sharing confidential genetic information and disclosing identifiable patient data for Quality and Outcomes Framework checks. (Source: EHI Primary Care)

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Equity in the distribution of community pharmacies in England: impact of regulatory reform

Journal of Health Services Research and Policy — Thu, 17 Sep 2009 23:00:00 +0100

Conclusion Deregulation was associated with more community pharmacies per capita and a small increase in geographic equity of community pharmacy distribution at PCT level. Future research should continue to monitor how pharmacy distribution changes over time and assess the extent to which the new regulatory framework has allowed clustering of pharmacies which could result in increased inequity below PCT level. (Source: Journal of Health Services Research and Policy)

QoF frozen as part of swine flu deal

EHI Primary Care — Tue, 15 Sep 2009 16:45:00 +0100

No changes will be made to the Quality and Outcomes Framework next year and some indicators will be dropped in 2011-12 under a deal agreed by the British Medical Association and NHS Employers on the swine flu vaccination programme. (Source: EHI Primary Care)

NICE publishes new indicators for possible future inclusion in QOF

NeLM - News — Sun, 13 Sep 2009 23:00:00 +0100

Source: NICE Area: News NICE has issued a press release detailing several proposed new Primary Care Quality and Outcomes Framework (QOF) Indicators, covering smoking, type 2 diabetes, palliative care, asthma and mental health. Please see the link below for details. (Source: NeLM - News)

Pay for perfomance and the quality of diabetes management in individuals with and without co-morbid medical conditions

JRSM — Thu, 03 Sep 2009 23:00:00 +0100

Conclusions Diabetes patients with co-morbid conditions appear to have benefited more from this pay-for-performance program than those without co-morbidity. (Source: JRSM)

Pay for perfomance and the quality of diabetes management in individuals with and without co-morbid medical conditions.

J R Soc Med AND (has... — Mon, 31 Aug 2009 23:00:00 +0100

CONCLUSIONS: Diabetes patients with co-morbid conditions appear to have benefited more from this pay-for-performance program than those without co-morbidity. PMID: 19734534 [PubMed - in process] (Source: J R Soc Med AND (has...)

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The UK Model for System Redesign and Chronic Kidney Disease Services

Seminars in Nephrology — Mon, 31 Aug 2009 23:00:00 +0100

Summary: The British National Health Service is a closed managed care system. This single health care system for the United Kingdom is funded by the government and paid for by general taxation. All UK citizens are registered with primary care physicians who control access to secondary care services. As a managed care system it should be able to offer integrated care across the whole patient pathway. In reality there are professional, organizational, and institutional barriers to coordination and delivery of care in the NHS. Historically, the United Kingdom has been among the lowest health care spenders of organizations for economic cooperation in developed countries, in absolute terms as well as proportion of the gross domestic product. However, since a Government pledge to place quality a...

[Editorial] NICE set to revise Quality and Outcomes Framework indicators

LANCET — Thu, 20 Aug 2009 23:00:00 +0100

On Aug 10, the UK's National Institute for Health and Clinical Excellence (NICE) published its first menu of new indicators for the Quality and Outcomes Framework (QOF). The QOF, a voluntary pay-for-performance scheme designed to reward UK general medical practices for provision of high-quality care, started in April, 2004. Incentives are paid on achievement of points for clinical indicators, practice organisation, and patient experience, and are devised to challenge practices to improve. (Source: LANCET)

NICE Publishes First Menu Of Potential New Indicators For The 2010/11 QOF

Health News from Medical News Today — Wed, 19 Aug 2009 11:00:00 +0100

The National Institute for Health and Clinical Excellence (NICE) has published the first menu of potential indicators for the 2010/11 Quality and Outcomes Framework (QOF) together with recommendations on indicators to be considered for retirement. (Source: Health News from Medical News Today)

Process measures face QoF chop

EHI Primary Care — Fri, 14 Aug 2009 12:15:00 +0100

Four potential new indicators for inclusion in next year's Quality and Outcomes Framework together with five indicators that could be removed from the QoF have been published. (Source: EHI Primary Care)

Quality and outcomes framework: GP incentives harm care quality

HSJ — Thu, 06 Aug 2009 09:00:00 +0100

The quality of care provided by GPs has decreased for some conditions where they do not receive performance related pay, a study has found. (Source: HSJ)

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QoF 'fails to promote access'

EHI Primary Care — Wed, 05 Aug 2009 11:48:46 +0100

The Quality and Outcomes Framework has failed to promote improved access or continuity in general practice, according to a new study. (Source: EHI Primary Care)

Quality down for non-QoF care

EHI Primary Care — Mon, 27 Jul 2009 00:00:01 +0100

The Quality and Outcomes Framework has led to a reduction in the quality of care for activities not included in the QoF and had a negative impact on continuity of care, according to a new study. (Source: EHI Primary Care)

NHS managers urge suspension of targets as swine flu calls rocket

Pulse Today Clinical Updates — Thu, 16 Jul 2009 11:28:00 +0100

NHS managers have put more pressure on the Government to look at suspending NHS targets - such as the Quality and Outcomes Framework - after figures show calls to GPs about the swine flu outbreak have risen by 50%. (Source: Pulse Today Clinical Updates)

Swine flu QoF negotiations ongoing

EHI Primary Care — Wed, 08 Jul 2009 16:03:07 +0100

Agreement to suspend the Quality and Outcomes Framework because of the impact of swine flu cases looks likely to be left to individual primary care organisations (PCOs). (Source: EHI Primary Care)