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QOF has narrowed health inequalities

By Lilian Anekwe

The Quality and Outcomes Framework has narrowed health inequalities by cutting admissions and deaths from heart disease most in deprived areas, new research shows.

The study - by public health specialists - is one of the first to show that the QOF can have a demonstrable impact on ‘hard' outcome indicators such as myocardial infarction and death.

The impact was strongest in practices in the most deprived areas, which had more than twice the reduction in admissions and deaths from CHD.

Researchers at the London Health Observatory calculated practice-level deprivation scores for 1,531 practices – 98% of all GP practices in the capital - over three years and studied the association between achievement in twelve clinical CHD indicators and related outcomes.

A one-point increase in the CHD quality achievement score cut the number of CHD admissions by 4.28 per 100,000 in practices serving populations with high levels of deprivation. This was more than twice the 2.11 per 100,000 decrease in admissions in practices in averagely deprived areas.

For CHD deaths, a 1-point increase in the CHD quality achievement score was associated with a 1.40 decrease in CHD deaths in areas with high deprivation compared to a 0.58 per 100,000 decrease in averagely deprived areas.

Dr Bobbie Jacobsen, director of the London Health Observatory, said the results suggest the best way to tackle health inequalities is to target resources at driving up QOF achievement in the most deprived areas.

Writing in the Journal of Epidemiology and Community Health Dr Jacobsen concluded: ‘Our findings suggest that if health inequalities are to be reduced, then the focus of attention should be on improving quality in practices serving deprived populations that performed less well on the QOF incentive scheme.'

Dr Kambiz Boomla, clinical senior lecturer at Queen Mary's, University of London and a GP in Tower Hamlets, east London said: ‘This excellent study demonstrates that the QOF has been successful in reducing health disparities and has resulted in improved CHD outcomes especially in deprived areas.'

‘In my view, QOF has been one of the most successful elements of the current GP contract, and has helped raise standards as well as focus high quality care where it is most needed.'

‘The QOF framework has been successful because doctors believe that the indicators matter to their patients. It is therefore important that any future changes in quality measures command the support of GPs alongside their changing roles.'

The study came as the latest report from the King's Fund inquiry into general practice, on tackling health inequalities, recommended QOF scores could be adjusted to reflect health inequalities, and argued that removing the ability to exempt patients from the QOF could also increase coverage of more vulnerable people.

Journal of Epidemiology and Community Health 2010;64:927-934.

High achievement in CHD indicators reduced admissions and deaths