Abstract
BackgroundA significant minority of patients do not receive all the evidence-based care recommended for their conditions. Health care quality may be improved by reducing this observed variation. Composite measures offer a different patient-centred perspective on quality and are utilized in acute hospitals via the ‘care bundle’ concept as indicators of the reliability of specific (evidence-based) care delivery tasks and improved outcomes. A care bundle consists of a number of time-specific interventions that should be delivered to every patient every time. We aimed to apply the care bundle concept to selected QOF data to measure the quality of evidence-based care provision.MethodsCare bundles and components were selected from QOF indicators according to defined criteria. Five clinical conditions were suitable for care bundles: Secondary Prevention of Coronary Heart Disease (CHD), Stroke & Transient Ischaemic Attack (TIA), Chronic Kidney Disease (CKD), Chronic Obstructive Pulmonary Disease (COPD) and Diabetes Mellitus (DM). Each bundle has 3-8 components. A retrospective audit was undertaken in a convenience sample of nine general medical practices in the West of Scotland. Collected data included delivery (or not) of individual bundle components to all patients included on specific disease registers. Practice level and overall compliance with bundles and components were calculated in SPSS and expressed as a percentage.ResultsNine practices (64.3%) with a combined patient population of 56,948 were able to provide data in the format requested. Overall compliance with developed QOF-based care bundles (composite measures) was as follows: CHD 64.0%, range 35.0-71.9%; Stroke/TIA 74.1%, range 51.6-82.8%; CKD 69.0%, range 64.0-81.4%; and COPD 82.0%, range 47.9-95.8%; and DM 58.4%, range 50.3-65.2%.ConclusionsIn this small study compliance with individual QOF-based care bundle components was high, but overall (‘all or nothing’) compliance was substantially lower. Care bundles may provide a more informed measure of care quality than existing methods. However, the acceptability, feasibility and potential impact on clinical outcomes are unknown.
Highlights
A significant minority of patients do not receive all the evidence-based care recommended for their conditions
It is widely accepted that there is a need to minimize unnecessary variation to improve the reliability of best practice care provision and the associated financial costs [2,3,4]
Given the benefits of the bundle approach in acute hospital settings, we aimed to develop care bundles based on those Quality & Outcomes Framework (QOF) disease areas and indicators in general practice that were judged to be most suitable
Summary
A significant minority of patients do not receive all the evidence-based care recommended for their conditions. Composite measures offer a different patient-centred perspective on quality and are utilized in acute hospitals via the ‘care bundle’ concept as indicators of the reliability of specific (evidence-based) care delivery tasks and improved outcomes. Wide variation in the provision of evidence-based care is recognized as a fundamental issue in all health care systems worldwide. The consequences of such variation often impact negatively on patients in terms of health care quality, safety, experiences and increased financial costs (including additional treatments and litigation) associated with sub-optimal clinical practices [1,2]. In general medical practice in the United Kingdom (UK) substantial variation in patient care has been described in anxiolytic, hypnotic, antidepressant and antibiotic prescribing [11,12,13]
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