Care home patients lose out under QOF, study suggests

GPs' achievement of QOF points in chronic disease indicators is poorer among patients living in care homes than for those in the community, UK research suggests.

Researchers led by Dr Sunil Shah from the University of London found GPs were more likely to exception-report care home residents from QOF indicators than those in the community. Writing in the BMJ, the researchers called for QOF to include more measures relevant to care home patients.

The team analysed records from 326 general practices in the UK. They identified over 10,000 patients in care homes and over 400,000 in the community, all aged 65-104. They found points achieved by practices in 14 out of 16 indicators relating to chronic illness were lower for residents of care homes than for those in the community.

Prescribing in heart disease and monitoring of diabetes were among the largest differences between the two patient groups.

Care home residents were more likely to be exception reported from all QOF targets for a condition. For example, 34% of patients with stroke in care homes were excluded compared with 17% in the community, and 35% compared with 9% for diabetes. Quality indicators for use of antiplatelet therapy and BP monitoring had the least difference.

Authors said the study shows a need to improve care for chronic diseases among older people in care homes. They concluded: ‘Our current findings support enhancement of pay for performance systems to include measures that are particularly relevant to residents of care homes and vulnerable older people in the community, such as pain management, falls and continence care.’

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