Rate GPs on QOF 'care bundles', not single targets

Rating GPs on whether patients receive all appropriate QOF checks for their conditions would improve performance measures, researchers believe.

Professor Helen Lester: interesting potential way for QOF to develop (photo: Pete Hill)

Far fewer patients hit targets for all QOF indicators for a condition than met each individual target, research by an NHS Education for Scotland team found.

In diabetes, individual indicator targets were met by 83-99% of patients, while only 58% met the targets for all indicators.

Lead researcher Paul Bowie told GP that looking at 'care bundles' could be a way for QOF to provide a more in-depth analysis of patient care.

'The care bundle approach has the potential to provide a more insightful measure of the quality of evidence-based care than the current approach, which focuses on compliance with individual indicators rather than individual patients,' the researchers said.

Mr Bowie and colleagues used data from nine practices in Scotland to uncover wide variations between individual target achievement and achievement of all targets across five areas: secondary prevention of CHD, stroke and TIA, chronic kidney disease, COPD and diabetes.

'We would suggest this "gap" in performance may be a more valid reflection of the variation in expected care delivery at patient level than current measures indicate,' they said.

Mr Bowie said that the care bundle approach could be scaled up to national level if supported by advanced IT and financial incentives and called for NICE's QOF committee to investigate it.

Professor Helen Lester, who leads piloting of potential QOF indicators, said NICE may want to look at using care bundles. 'It would be an interesting potential way for QOF to develop,' she said. 'If explained properly, it could tell patients more about differences in the care on offer for a particular long-term condition between practices.'

A NICE spokeswoman said QOF already incorporated some bundled indicators involving multiple measures.

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