Overall, the management of people with diabetes improved over the study period, but the influence of QOF was not straightforward, the researchers found.
The diagnostic case definition for diabetes used in the framework excludes up to one third with type-2 diabetes from coding on QOF.
Many patients who are not receiving optimal care may be excluded from QOF assessment, in particular, younger people, women and people from less affluent backgrounds.
Coding needs to be standardised to ensure quality of care is monitored in an unbiased way, the researchers said.
In addition, because payment thresholds only require that a certain proportion of patients meet targets, there are no incentives for improving the care of many patients, they said.
They suggested that greater thought be given to targeting poorly performing practices than amending indicators.
- BMJ 2009; 338: b1870.
Comment below and tell us what you think