Saul Galloway wrote:
IMO the "performance" it pays for and "rewards" is largely administrative.
If I were in Oz considering implementing a quality system from scratch I
would not go for QOF. From the patient/public perspective I would look more
to a system which encouraged (moving to mandated) clinical outcome
measurement and comparison, and ensured that patient flows were directed
increasingly to the best performers.
Who is the best knee surgeon for a TKR for OA knee in a 75 year old local
(say within 50 miles) to you Mary? How would you know, and what factors
might be considered to be taken into account in assessing excellence. How
does his results (adjusted for casemix OFC) compare to results nationally or
internationally?
Measure the clinical outcomes (especially the long term ones) by condition
(across primary and secondary care), case adjust, make them public and
accessible. Now that would be the basis for a quality improvement program
that I *would* sign up to.
A very thoughtful debate, thank you all. Can I quote you on the above, Saul?
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Cheerio,
Graham
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