Quality in primary care
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Quality in primary care · Jan 2010
ReviewA review of the public health impact of the Quality and Outcomes Framework.
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. ⋯ The evidence is equivocal as to whether improvements in clinical care and the narrowing gap in performance are influenced by the incentives created by the QOF or whether this translates into reduced health inequalities. Even though the QOF is only part of the range of incentives which affects practices, it is vital that indicators are aligned to the objective of reducing health inequalities. Additional research is needed to understand whether the QOF ensures that those who are the most difficult to reach and those whose need of care is greatest are getting access to high quality primary care and whether in turn it will succeed in reducing health inequalities.
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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.
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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.