Quality in primary care
-
Quality in primary care · Jan 2011
Reducing variation in general practitioner referral rates through clinical engagement and peer review of referrals: a service improvement project.
General practitioner (GP) referral rates to hospital services vary widely, without clearly identified explanatory factors, introducing important quality and patient safety issues. Referrals are rising everywhere year on year; some of these may be more appropriately redirected to lower technology services. ⋯ This intervention appeared acceptable to GPs because of its emphasis on reviewing appropriateness and quality of referrals and was effective and sustainable while the investment in resources continued. Consultant involvement in discussions appeared important. The intervention's cost-effectiveness requires evaluation for consideration of future referral management strategies.
-
Quality in primary care · Jan 2011
Does a general practitioner support unit reduce admissions following medical referrals from general practitioners?
Emergency medical admissions to UK hospitals have been increasing steadily over the past few decades and there are likely to be a proportion of these admissions that are avoidable. This evaluation aims to demonstrate whether a general practitioner support unit (GPSU) reduces general practitioner (GP) referred emergency medical admissions to an acute hospital. ⋯ An acute GP led service run from within the hospital to provide support to community GPs led to a modest reduction in the number of GP admissions to the MAU, but did not reduce the number of GP admissions to the hospital wards.
-
Quality in primary care · Jan 2010
Developing Quality and Outcomes Framework (QOF) indicators and the concept of 'QOFability'.
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. ⋯ However, what are the attributes of a good QOF indicator and how do these differ from those of a good quality indicator, such as validity and sensitivity to change? This paper describes the concept of 'QOFability', which relates to why some areas are, and others are not, prioritised for the QOF. Factors include the prevalence of the clinical issue, the accuracy of data extraction from GP clinical systems, the clarity of diagnosis, the relevance of incentivised actions, the direct attribution to all primary care staff and consideration of any possible unintended consequences of introducing any given indicator. The paper concludes by considering the future direction of the QOF, recommending a focus on creating feasible, valid, reliable and piloted 'QOFable' clinical indicators.
-
Quality in primary care · Jan 2010
An international perspective on the basis for payment for performance.
This discussion paper reflects on the pay-for-performance system in UK general practice - the Quality and Outcomes Framework (QOF) - from an international viewpoint. The QOF intends to bring the best scientific evidence to bear on primary care practice. However, the QOF and patient-centred medicine are often at odds. ⋯ The extent of impact of the QOF on health outcomes and on equity of health outcomes needs examination. Attention to resolution of patients' problems is an important aim of quality improvement activities. Alternative modes of improving patient care may be better than the QOF.