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 used in QOF for diabetes excludes up to one third with type-2 diabetes from coding on QOF.
Coding needs to be standardised to ensure quality of care is monitored in an unbiased way, the researchers said.
In addition, because payment thresholds require only that a certain proportion of patients meet targets means, there are no incentives for improving the care of many patients, the researchers said.
They suggest that greater thought be given to targeting poorly performing practices, rather than amending indicators.
- BMJ 2009;338:b1870
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