QOF Plus Year 1 - Imperial College London

Appendix 2Methodology for the extension ofexisting clinical QOF targetsSelection of candidate existing indicators for revised upper thresholdsBecause the initial remit of the QOF+ Development Group concerned improving aspects of clinicalcare, it was decided that only indicators in the QOF clinical domain be considered for furtherincentivisation through QOF+. The additional services indicator for cervical screening wassubsequently appended to that list as it had been identified through the local Public Healthreport and by the PCT as a key priority area for Hammersmith and Fulham ( see Graph A3.3.6.1,p123).Analysis of data compiled by the group on local practice achievement for existing QOF indicatorsin 2006/7 found that most practices in Hammersmith and Fulham were achieving well on processindicators. It was therefore decided to reward achievement of revised upper thresholds for aselected number of outcome and process indicators where there was scope for furtherimprovement.The list of candidate indicators was refined following consultation with local practices andresulted in the removal of EP 8 and COPD 10 in view of the limited evidence base and thepotential for these indicators to exacerbate health inequalities. Following a series of face-to-faceand email discussions, the list was reduced to 12 indicators, spanning key areas of morbidity forHammersmith and Fulham:ASTHMA 6, BP 5, CHD 6, CHD 8, CHD 10, CS 1, DM 12, DM 17, DM 20, MH 6, STROKE 6and STROKE 8 (see also Table A2.1, below).Data compiled by the group on individual practice attainment in QOF 06/07 and 07/08 were usedto inform this process. While there was continued general improvement between QOF 06/07 andQOF 07/08, the selected indicators still represent the 12 worst-performing areas forHammersmith and Fulham.102