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Quality and outcomes in primary care Josip Car

Quality and outcomes in primary care Josip Car. Quality and outcomes framework (QOF). A national programme for quality improvement in primary care Launched in 2004 as part of the revised GP contract Pay-for-performance 132 chronic disease and administrative targets.

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Quality and outcomes in primary care Josip Car

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  1. Quality and outcomes in primary care Josip Car

  2. Quality and outcomes framework (QOF) A national programme for quality improvement in primary care Launched in 2004 as part of the revised GP contract Pay-for-performance 132 chronic disease and administrative targets

  3. Quality and outcomes framework (QOF) Concrete evidence of improvement in areas covered by targets with consequential impacts on disease and mortality Campbell et al., 2007;Millett et al., 2008; Millett et al., 2009; Khunti et al., 2007; Mason et al., 2008; Shohet et al., 2007 But... Perpetuating inequalities McLean et al. 2006; Millett et al., 2009or not? Doran et al., 2008; Millett et al., 2009 , Crawley et al. 2009 Halo effects Campbell et al., 2007; Sutton, 2010 or all-consuming?Steel et al., 2007 Methodological flaws? Guthrie et al., 2006; McLean et al. 2006 Too easy? Fleetcroft et al., 2008 The wrong focus? Darzi, 2008

  4. Local schemes Developed in response to the limitations of QOF Better fit with local need Increased focus on primary prevention Capitalise on an existing mechanism NHS Stoke on Trent NHS Wandsworth NHS Halton and St Helens NHS Cambridgeshire and...

  5. NHS Hammersmith and Fulham Commissioning-academic partnership with Imperial College London £2.5 million joint venture Planning commenced June 2008 Launched December 2008 Slated to run until 2011

  6. Looking back... Concrete evidence of improvement in areas covered by targets with consequential impacts on disease and mortality Campbell et al., 2007;Millett et al., 2008; Millett et al., 2009; Khunti et al., 2007; Mason et al., 2008; Shohet et al., 2007 But... Perpetuating inequalities McLean et al. 2006; Millett et al., 2009or not? Doran et al., 2008; Millett et al., 2009 , Crawley et al. 2009 Halo effects Campbell et al., 2007; Sutton, 2010 or all-consuming?Steel et al., 2007 Methodological flaws? Guthrie et al., 2006; McLean et al. 2006 Too easy? Fleetcroft et al., 2008 The wrong focus? Darzi, 2008 And.... A missed opportunity?

  7. Looking forward... Clinical engagement and ownership Transparent design Training Financial incentives Dedicated support Innovative IT tools

  8. The components of QOF+ Primary prevention Cardiovascular disease primary prevention Alcohol misuse in at-risk groups Smoking cessation Smoking in pregnancy Breastfeeding uptake New entrant TB screening Care in vulnerable patient groups Carer status recording Ethnicity and first language recording Higher targets for selected existing QOF indicators

  9. Highlights from year 1 Smoking 128,118 (84%) people over 15 years old had smoking status recorded 79% of the 26072 smokers identified were given smoking cessation advice and referred to smoking cessation services Smoking in Pregnancy 2,054 (98%) pregnant women had smoking status recorded at booking 92% of the 168 smokers identified were given smoking cessation advice and referred to smoking cessation services

  10. Highlights from year 1 Alcohol screening and intervention 15,788 screened 2,724 (17%) screened positive 2,258 (83%) received brief intervention

  11. Asthma checks ASTHMA 6 870 extra patients with an annual asthma review 8650 patients with asthma Prevalence 4.65% → 4.72% 315 extra patients

  12. Blood pressure control BP 5, CHD 6, DM 12, STROKE 6 1800 extra patients with adequate BP control 28254 patients Prevalence 15.01 % → 15.43% 1350 extra patients

  13. Cholesterol control CHD 8, DM 17, STROKE 8 590 extra patients with cholesterol control 10973 patients Prevalence 5.85 % → 5.99% 490 extra patients

  14. Mental health plans MH 6 360 extra patients with a care plan 2110 patients with mental health issues Prevalence 1.03 % → 1.15% 260 extra patients

  15. Summary The local QOF model can be implemented in practice Some clear positive progress to date Plenty of scope for improvement Formal evaluation to start in summer 2010 with Imperial College London

  16. An opportunity for study There is clearly still plenty of scope for improvement! Shifts in the focus of care into the community – strengthened by the coalition plan for GP-lead commissioning – come at a time when funding will be reduced We perceive a methodological gap about best to do this. Is there a also translational gap for implementation of QI in primary care?

  17. Existing QOF indicators 1/2 QOF QOF+ Points Continued...

  18. Existing QOF indicators 2/2 QOF QOF+ Points

  19. New clinical QOF+ indicators 1/4 Payment stages Points

  20. New clinical QOF+ indicators 2/4 Payment stages Points

  21. New clinical QOF+ indicators 3/4 Payment stages Points

  22. New clinical QOF+ indicators 4/4 Payment stages Points

  23. New non-clinical QOF+ indicators 1/4 Points

  24. New non-clinical QOF+ indicators 2/4 Points Continued...

  25. New non-clinical QOF+ indicators 3/4 Points

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