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Local QOF targets ‘failed to improve clinical care’, study says

Locally extended QOF targets do not provide clinical benefits to GP patients, a study has suggested.

A team of researchers studied the effects of the ‘QOF+’ programme run in GP practices in the London borough of Hammersmith and Fulham since 2008, which saw practices offered additional payments for achieving local targets on diabetes, hyper-tension, coronary heart disease (CHD) and stroke.

Though these ‘stretch’ payments significantly boost to achievement of quality indicator targets, researchers from the Department of Primary Care and Public Health at Imperial College London found this was largely a result of increased exception reporting.

A major objective for the scheme was to ‘accelerate improvements in existing national QOF targets’ through funding these extra targets.

But the research paper, published in PLoS ONE, said: ‘The local pay for performance program led to significantly higher target achievements (hypertension: p-value <0.001, coronary heart disease: p-values <0.001, diabetes: p-values <0.061, stroke: p-values <0.003) However, the increase was driven by higher rates of exception reporting (hypertension: p-value <0.001, coronary heart disease: p-values <0.03, diabetes: p-values <0.05) in patients with all conditions except for stroke.’

It added that ‘the programme was not associated with discernible improvements in overall clinical quality’.

The paper concluded that policy makers should look closely at exception reporting, and define acceptable exception levels, when designing future ‘stretch’ QOF schemes.

It said: ‘Exception-reported patients are less likely to achieve clinical targets and the impact of their exclusion is to increase the cost to the scheme of each patient who does meet the targets.

‘Therefore, implementation of pay-for-performance programmes should be accompanied by measures to prevent higher exception reporting.’

PLoS ONE 2015; available online 26 March


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