NICE advisor calls for QOF overhaul to measure hospital admission

QOF must be overhauled to measure 'true' outcomes, such as hospital admission, if it is to improve chronic disease care, a senior NICE advisor has said.

National guidelines are not being followed to prevent hospital admissions
National guidelines are not being followed to prevent hospital admissions

Current QOF targets are little more than process-driven, tick-box measures, according to London GP Dr Mark Levy, who was appointed respiratory expert advisor for QOF at NICE last year.

Indicators that measure the actual outcome of care are needed to drive standards in chronic disease management, even if they are unpopular with some in the profession, he said.

Dr Levy told GP: ‘We need more outcome-driven QOF indicators like, for example, readmission for acute asthma. That will drive change.’

He added: ‘That's the thing that would make a difference. And it's not just asthma, it's most chronic diseases’.

But he admitted the idea may be unpopular with GP leaders. 'The GP politicians would say no, [because] you can tick a box to say you have done an asthma review, but you can't tick a box to say [you have] reduced readmissions.'

In a speech at the European Respiratory Society (ERS)) annual congress in Amsterdam, the Netherlands this week, Dr Levy singled out key issues that still persist among primary care treatment for asthma: 'Systemic steroids are still underused. Objective measures [to assess patients] are still underused. There is inadequate routine management and national guidelines are not being followed.'

Dr Levy also urged GPs to encourage patients with asthma who smoke to stop as a first step to reducing hospital admissions: 'Patients come into GP surgery, we ask them if they smoke. We tick the box, but we don't take it further.'

He is leading a National Review of Asthma Deaths, a project by the Royal College of Physicians to investigate how and why 1,200 people die from asthma each year. Around nine in 10 asthma deaths are believed to be preventable.


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