Graham Balin wrote:
> Discussion rages in Aus about how far to copy the UK. Many pundits
> stating categorically that the QoF has been shown to be a failure. [with
> no references]
>
> Is there any 'evidence' out there? Yeah, sure there will always be docs
> who play the system to patient's detriment, but has there been any sign
> of an overall improvement in standards of care? If no, is that because
> there is evidence of no improvement, or just lack of robust data?
>
I don't have my reference manager to hand so that will have to follow
later but it is safe to say that the evidence for change is pretty thin.
This is largely because there was not control group, or even any real
measurement of what was happening before the introduction of QOF.
First off, there is no evidence of systematic cheating. There was a
paper from York (non peer reviewed) a couple of years ago claiming there
was but the evidence did not support its conclusions. Several other
sources have found no evidence.
One area we have a little more evidence than others is in diabetes care.
The national diabetes audit asked much the same questions before QOF and
after it. There was some improvement in highly coded things (BP, HbA1c)
although this may have been part of an ongoing trend. There was a huge
rise in things that were not previously coded well (foot assessment,
retinal screening) but were needed for payment. QOF certainly seems to
have increased coding.
Agreement between QOF registers, secondary care measures and population
measurements seems virtually non existent.
In the early days of QOF affluent areas did better. This gap has reduced
markedly in the later years.
There is some general international agreement that QOF makes up too much
of the GP income. Incentive payments are thought should make up no more
than 10% of income, although data for this comes largely from the US.
I will post some references later.
--
Gavin
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