Exception reporting in the Quality and Outcomes Framework: views of practice staff – a qualitative study

Campbell, Stephen; Hannon, Kerin L; Lester, Helen

doi:10.3399/bjgp11x567117

Cited by 21 publications

(19 citation statements)

References 18 publications

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“…Use of exception reporting to achieve targets has been previously reported and terminal-digit bias has been associated with misclassification around blood pressure targets. 46,47 Hypertension prevalence is greater in lower socioeconomic groups, and there are concerns that implementation of the QOF may have contributed to the inverse care law. 2,48 Further analysis of an appropriately powered dataset is needed to fully understand the implications of this finding.…”

Section: Implications For Research and Practicementioning

confidence: 99%

Trends in the diagnosis and management of hypertension: repeated primary care survey in South West England

Mejzner

Clark

Smith³

et al. 2017

Br J Gen Pract

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Trends in the diagnosis and management of hypertension:repeated primary care survey in South West England e306 British Journal of General Practice, May 2017 UK, from 18 January 2016 as an online (SurveyMonkey ® ) questionnaire. Invitations to participate were first sent in an e-mail with a link to the survey to all practices registered with the Clinical Research Network. Similar invitations were then included in the electronic newsletters of Cornwall, Devon, and Somerset local medical committees to all practices across the three counties; reminders were sent in the newsletters 2 months later. The paper version of the questionnaire was distributed to delegates attending a clinical research network meeting in early 2016, and in June the paper questionnaire was posted with a reply paid envelope to the managers of all non-responding practices, with a request to pass to the practice hypertension lead. Data collection was completed at the end of July 2016. Sample sizeThis was a follow-up survey so no formal sample size calculation was performed. AnalysisData from replies were collated on an Excel spreadsheet with the published data from the QOF year ending March 2015. QOF provides individual practice-level data on list size, numbers with hypertension (the hypertension register), and practice prevalence for hypertension. The QOF contract sets a blood pressure target of ≤150/90 mmHg to be achieved for 80% or more patients on the register; individuals can be excepted from this target where it is deemed clinically inappropriate or they do not attend for care. Consequently, the QOF data include both an unadjusted target achievement rate using the denominator of all patients on the hypertension register (the raw achievement), and an adjusted achievement rate where excepted patients are omitted from the calculation (the net achievement). Numbers and rates for exception reporting are also provided for all practices. 16 Where duplicate responses were received from a practice, the most complete version was entered, or, if both were complete, the first reply received. Anonymous responses were included in the reported survey findings but not in analyses by location or outcome QOF data.Variations in QOF data were explored with Pearson's correlation coefficients, and characteristics of responding and non-responding practices were compared using t-tests or χ 2 tests as appropriate to the data. Trends in proportions across the three surveys were tested with the extended Mantel-Haenszel χ 2 for linear trend, and comparisons of QOF outcome data with organisational factors were made using t-tests. RESULTS ResponsesThe questionnaire was distributed to all 305 practices in Cornwall, Devon, and Somerset, and 117 individual practice responses were received (38% response rate). Response rates in 2007 and 2010 were 31% and 34%, respectively (P = 0.24 for trend).9 Sixteen replies were anonymous so could not be linked to QOF outcome data, but were included in the survey findings. How this fits inPrevious surveys have suggested a shift from GP t...

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Section: Implications For Research and Practicementioning

confidence: 99%

Trends in the diagnosis and management of hypertension: repeated primary care survey in South West England

Mejzner

Clark

Smith³

et al. 2017

Br J Gen Pract

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“…However, the abuse of exception reporting (which allows family practitioners to exclude patients from in dividual or groups of indicators) has not been as widespread as administrators feared. [33][34][35] Physi cians remain convinced that it is important for them to exclude patients from indicators that they regard as inappropriate for individual pa tients. This flexibility is a key part of maintain ing professional buyin and removing incentives for family practitioners to disenroll problematic patients ("cherry picking") or to provide treat ment that the practitioner judges is not in the patient's interest.…”

Section: Unintended Consequencesmentioning

confidence: 99%

Successes and Failures of Pay for Performance in the United Kingdom

Roland¹,

Campbell²

2014

N Engl J Med

Self Cite

102

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In 2004, the United Kingdom introduced one of the world's largest payforperformance pro grams, the Quality and Outcomes Framework, with a quarter of the income of family practi tioners tied to measures of their performance. 1 Since then, much research has been conducted to answer the question "Does pay for perfor mance improve the quality of health care?" This research has included more than 20 systematic reviews and now 1 systematic review of system atic reviews. 2 As a summary of this increasing body of work, it is clear that pay for performance can be effective. However, the effects are some times only shortterm and are often not as large as payers wish. The effect of incentives is depen dent on the context in which they are introduced, and payforperformance programs always have the potential to produce unintended conse quences. This leads to many unanswered ques tions about how such programs can best be in troduced 3 and suggestions from a range of countries on the key design issues that need to be considered. 4-7

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“…It recognises that not all patients are suitable candidates for medical interventions, either for clinical reasons (e.g. 'patient unsuitability' or 'on maximum tolerated treatment') or because patients refuse the treatment offered, referred to as 'informed dissent' (Campbell et al, 2011).…”

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confidence: 99%

The Quality and Outcomes Framework: Body commodification in UK general practice

Norman¹,

Russell

Merli

2016

Social Science & Medicine

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Additional information:Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. programme. These environments provided the opportunity for studying various spaces such as QOF meetings, consultation rooms, QOF recoding sessions, and the collection of computer-screen images depicting how patients' biomarkers are evaluated and costed through software systems. QOF as a biomedical technology has led to the commodification of patients and their bodies. This complex phenomenon breaks down into three main themes: commodification of patients, QOF as currency, and valuing commodities. Despite the ostensible aim of QOF being to improve healthcare in general practice, it is accompanied by a body commodification process. The interface between patients and care providers has been commodified, with QOF's pricing mechanism and fragmentation of care provision performing an important role in animating the UK economy.

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Exception reporting in the Quality and Outcomes Framework: views of practice staff – a qualitative study

Cited by 21 publications

References 18 publications

Trends in the diagnosis and management of hypertension: repeated primary care survey in South West England

Trends in the diagnosis and management of hypertension: repeated primary care survey in South West England

Successes and Failures of Pay for Performance in the United Kingdom

The Quality and Outcomes Framework: Body commodification in UK general practice

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