Diabetes QOF ‘needs reassessment’
medwireNews: Researchers say that the Quality and Outcomes Framework (QOF) for diabetes, introduced in 2004, has lead to initial improvements in patient care, but with only modest improvements seen beyond the first year, the cost of the scheme may need reviewing.
Using the General Practice Research Database (GPRD), Evangelos Kontopantelis (University of Manchester) and team gathered patient-level data from 2000-2007 for 23,789 patients with diabetes from 148 practices in England.
The recorded quality of care increased for all 17 indicators during the study period and a composite quality of care score increased from 46.5% in 2000/1 to 81.0% in 2006/7.
The greatest improvements occurred in the first year of the scheme, when there was an improvement in composite score of 14.2% - over and above that expected from the pre-intervention trend. By the third year, improvement above the pre-intervention was smaller, although still significant, at 7.3%.
The team says the modest improvements in patient gain in the later years of the study may be due to the achievement of some indicators being close to 100% and most practices exceeding the maximum payment thresholds for most indicators in the first year, meaning there was limited financial incentive for further improvement.
Noting the pre-intervention trend for improvement, Kontopantelis and colleagues write in BMJ Quality & Safety: "As a result, the QOF may not ultimately have resulted in higher quality of care than would have eventually been achieved in its absence.
"The high annual cost of the QOF scheme - over £1 billion per year, with almost 10% allocated to diabetes care - needs to be assessed in this light," they add.
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By Sally Robertson