Quality And Outcomes Framework Points Research Articles

Shaping district diabetes services: a novel performance index scoring system to successfully negotiate with Clinical Commissioning Groups

Aims: To establish whether a recently reported performance index scoring system developed in two diverse populations (Medway and Guildford, UK) could be used to successfully negotiate with a Clinical Commissioning Group (CCG) to shape diabetes services and set priorities.Methods: We collated demographic details for the area’s population with diabetes with diabetes scores from local primary care Quality and Outcomes Framework (QOF) records, together with exception reporting. Data from Hospital Episode Statistics and Dr Foster were used to record the Standardised Admission Rate (SAR) for a first/new referral to a secondary-care diabetes outpatient appointment or for emergency admission to hospital for diabetes. Hospital notes for patients from one GP practice were reviewed to clarify why patients were seen in secondary rather than primary care.Results: The prevalence of diabetes was low (4%) compared with figures from the Strategic Health Authority (SHA) (4.5%) and nationally (5.6%). Total diabetes QOF points achieved (99.3) were higher than for the SHA (97.8) and nationally (95.3); 61.1% achieved HbA1c <7%, which was much higher than the SHA (57.2%) or national average (54.3%). The exception-reporting rate (9.8%) was lower than the SHA (10.5%) or national average (14%). The SAR was lower than the Surrey average for a first outpatient visit (87.8 vs. 128.9) or emergency admissions (85 vs. 106.7).Conclusions: The performance index scoring system enabled an assessment of diabetes care that transcended primary and secondary care. A successful negotiation took place between the local diabetes stakeholders and the CCG with a plan for improving and developing the current model of care. The scoring system is applicable to any district in the UK and may be of interest to clinicians and commissioners.

Exploration of population and practice characteristics explaining differences between practices in the proportion of hospital admissions that are emergencies.

BackgroundEmergency (unscheduled) and elective (scheduled) use of secondary care varies between practices. Past studies have described factors associated with the number of emergency admissions; however, high quality care of chronic conditions, which might include increased specialist referrals, could be followed by reduced unscheduled care. We sought to characterise practices according to the proportion of total hospital admissions that were emergency admissions, and identify predictors of this proportion.MethodThe study included 229 general practices in Leicestershire, Northamptonshire and Rutland, England. Publicly available data were obtained on scheduled and unscheduled secondary care usage, and on practice and patient characteristics: age; gender; list size; observed prevalence, expected prevalence and the prevalence gap of coronary heart disease, hypertension and stroke; deprivation; headcount number of GPs per 1000 patients; total and clinical quality and outcomes framework (QOF) scores; ethnicity; proportion of patients seen within two days by a GP; proportion able to see their preferred GP. Using the proportion of admissions that were emergency admissions, seven categories of practices were created, and a regression analysis was undertaken to identify predictors of the proportion.ResultsIn univariate analysis, practices with higher proportions of admissions that were emergencies tended to have fewer older patients, higher proportions of male patients, fewer white patients, greater levels of deprivation, smaller list sizes, lower recorded prevalence of coronary heart disease and stroke, a bigger gap between the expected and recorded levels of stroke, and lower proportions of total and clinical QOF points achieved. In the multivariate regression, higher deprivation, fewer white patients, more male patients, lower recorded prevalence of hypertension, more outpatient appointments, and smaller practice list size were associated with higher proportions of total admissions being emergencies.ConclusionIn monitoring use of secondary care services, the role of population characteristics in determining levels of use is important, but so too is the ability of practices to meet the demands for care that face them. The level of resources, and the way in which available resources are used, are likely to be key in determining whether a practice is able to meet the health care needs of its patients.

Impact of pay for performance on prescribing of long-acting reversible contraception in primary care: an interrupted time series study.

BackgroundThe aim of this study was to evaluate the impact of Quality and Outcomes Framework (QOF), a major pay-for-performance programme in the United Kingdom, on prescribing of long-acting reversible contraceptives (LARC) in primary care.MethodsNegative binomial interrupted time series analysis using practice level prescribing data from April 2007 to March 2012. The main outcome measure was the prescribing rate of long-acting reversible contraceptives (LARC), including hormonal and non hormonal intrauterine devices and systems (IUDs and IUSs), injectable contraceptives and hormonal implants.ResultsPrescribing rates of Long-Acting Reversible Contraception (LARC) were stable before the introduction of contraceptive targets to the QOF and increased afterwards by 4% annually (rate ratios = 1.04, 95% CI = 1.03, 1.06). The increase in LARC prescribing was mainly driven by increases in injectables (increased by 6% annually), which was the most commonly prescribed LARC method. Of other types of LARC, the QOF indicator was associated with a step increase of 20% in implant prescribing (RR = 1.20, 95% CI = 1.09, 1.32). This change is equivalent to an additional 110 thousand women being prescribed with LARC had QOF points not been introduced.ConclusionsPay for performance incentives for contraceptive counselling in primary care with women seeking contraceptive advice has increased uptake of LARC methods.

Increasing the QOF upper payment threshold in general practices in England: impact of implementing government proposals

General practices in the UK receive incentive payments for managing patients with selected chronic conditions under the Quality and Outcomes Framework (QOF) scheme. Payments are made when a negotiated threshold percentage of patients receive the appropriate intervention. From 2013-2014 in England the Department of Health has proposed that this negotiated threshold is replaced with a value equal to the 75th percentile of national performance to attract maximum payments. This is an investigation of the potential impact of this change on practice income and workload. Analysis of 2011-2012 QOF dataset (the latest available) which covers 8123 GP practices and 55.5 million patients in England. The 75th percentile of performance was calculated for 52 clinical indicators and applied to 2011-2012 performance. Estimations were made of financial and workload impacts on practices, and whether practices with different characteristics would be disproportionately affected. The proposed changes will result in an increase in the upper payment threshold of each clinical indicator by a mean of 7.47% (range 2.16-38.87%). If performance remains static practices would lose a mean of 47.68 (0-108.33) QOF points, equivalent to a mean financial change of -£279.60 (-£35 352.50 to +£19 957.78) per practice for these 52 indicators. Increasing the QOF upper payment threshold to the 75th percentile of national performance will, if clinical performance remains static, substantially reduce the mean number of QOF points achieved per practice. However, this translates into only a small mean loss of income per practice.

Revision of Scottish GP contract removes one in four QOF points

Changes to the GP contract in Scotland have been agreed for 2014-15, including the removal of one in four points from the Quality and Outcomes Framework (QOF).1 As part of the changes, agreed by the British Medical Association’s Scottish General Practitioners Committee and the Scottish government, 264 points will be removed from QOF, leaving a total of 659 points. To offset funding lost through …

057 Has a pay for performance strategy in primary care improved epilepsy management in the UK?

IntroductionThe New GP Contract (2004) introduced reward for achievement in quality of organisation and disease management. We investigated how a pay for performance strategy has affected epilepsy care as measured...

General practice size determines participation in optional activities: cross-sectional analysis of a national primary care system

Background: There is widespread, unexplained variation in activity and outcome between general practices. Aim: To explore the relationship between practice size and participation in optional activities, including the Quality and Outcomes Framework (QOF). Design of study: Cross-sectional analyses of routinely available data on practice characteristics, QOF performance and optional activities including undergraduate teaching, postgraduate training, research, enhanced clinical data collection and service development. Setting: All 1031 general practices were located in mainland Scotland. Results: The most popular optional activity was undergraduate medical teaching, which involved 41% of all general practices. About a third of practices took part in postgraduate general practitioner training (29%), research (33%), enhanced clinical data collection through the Scottish Programme for Improving Clinical Effectiveness (31%) and the activities of the Scottish Primary Care Collaborative (33%). The most important driver of the number of activities undertaken by a practice is size with single handed, small and medium sized practices all undertaking a significantly lower number of activities than larger practices (P < 0.001). Deprivation had no overall effect, but was associated with lower rates of participation in postgraduate training. The average number of points achieved in the QOF ranged from 961 by the 18% of practices taking part in no optional activities, to 973 by 29% of practices taking part in one activity, 984 by 25% of practices taking part in two activities and 985 in 28% of practices taking part in three or more activities. Single handed practices in urban areas taking part in three or more additional activities had similar QOF point totals to larger practices taking part in three or more activities, and achieved 44 more QOF points than urban single-handed practices taking part in less than two additional activities. Conclusions: Practice size is strongly related to participation in optional activities. There is a small but significant relationship between the practice size and number of QOF points achieved by practices taking part in less than two additional activities. Participation in optional activities is a possible indicator of cultural and organisational factors within practices, which constrain the volume and quality of services, which they are able to provide.