QOF Plus Year 1 - Imperial College London

Lower Upper PointsPractices ≥UpperASTHMA 6 40% 70% 20 28BP 5 40% 70% 57 25CHD 6 40% 70% 19 29CHD 8 40% 70% 17 24CHD 10 40% 60% 7 24CS 1 40% 80% 11 4DM 12 40% 60% 18 26DM 17 40% 70% 6 23DM 20 40% 50% 17 27MH 6 25% 50% 6 28STROKE 6 40% 70% 5 27STROKE 8 40% 60% 5 22Table A2.1Summary of current QOF targets and point allocations for the 12 indicators selected for target revisionin QOF+. The number of Hammersmith and Fulham practices already exceeding the QOF upper boundis shown (calculated from QMAS data as at June 2008).Methodology for revised target setting for existing clinical indicatorsAn early principle established by the QOF+ Development Group was that revised targets be set ina way that drives standards towards the best seen at a national level. The original plan was for asingle ‘all-or-nothing’ target set at the 90 th national centile of attainment or 90%, whichever waslower, for a given indicator.A number of problems became apparent with this approach, notably the uneven distribution ofperformance for the 12 selected indicators when local and national statistics were compared(using QOF 07/08 data, see Appendix 3, p116). For some indicators (particularly CHD 8 andSTROKE 6) this meant that significant numbers of practices already displayed attainment thatbrought them close to the 90% threshold, while for others (e.g. CS 1) the desired improvementwas unrealistic (in a single year).To explore this issue further, the group introduced the concept of median distance ̃ , calculatedas the median of the differences between any proposed target and the current level ofattainment for each Hammersmith and Fulham practice, :{ } , ̃ (1)This was converted into a figure representing the number of patients that the medianHammersmith and Fulham practice (of 4975 patients, prevalence figures in Table A2.2) wouldhave to treat to reach the target:⌈ ̃ ⌉ (2)103