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QOF ‘may have undermined care in children’

The introduction of the QOF in 2004 may have had the unintended negative consequence of worsening care and increasing hospital admissions for children, a study has found.

Research in the Annals of Family Medicine assessed the impact of the 2004 contract and identified an 8% increase in short-stay admissions among children with primary-care sensitive chronic conditions immediately after the contract’s introduction.

With fewer than 3% of QOF targets aimed at improving care for children the study notes it is  ‘particularly concerning’ that ‘admission rates among children with chronic conditions… are now surpassing other causes of admission in older children’.

Between April 2000 and March 2013, there were 7.8 million unplanned hospital admissions for children younger than 15, with 4.1 million of these short-stay admissions for potentially avoidable infections and chronic conditions.

The reforms in April 2004 saw an 8% increase in short-stay admissions for chronic conditions, in addition to the 3% annually increasing trend, and equivalent to roughly 8,500 additional admissions.

The study notes there was an accompanying decrease in admissions referred by a GP after the changes came in to force, with more children being admitted by hospitals instead.

Though the study did not test a causative link, the 11% increase in children with long-term conditions admitted after the 2004 contract imposition leads the authors to suggest: ‘This development may indicate an adverse impact of financial incentive schemes focusing on chronic conditions.’

Ann Fam Med 2015; available online 11 May