QOF Plus Year 1 - Imperial College London
QOF Plus Year 1 - Imperial College London QOF Plus Year 1 - Imperial College London
Methodology for the development of new indicatorsIn addition to the indicator areas selected through the structured local consultation, the groupdeveloped new indicators for ethnicity recording (incorporating recording of first language) anddata quality (records). In addition, funding was made available by the PCT in the later stages ofthe project for the incentivisation of indicators relating to additional non-clinical domains. Toinform development of new QOF+ non-clinical indicators, a member of the group conducted aninitial brief review to assess the importance of each indicator area (on the basis of nationalguidance and the local context), which Healthcare Commission core standards would be met byinclusion of the proposed indicators, and the anticipated training and development needs.For each selected new indicator area, a literature review of the evidence base was undertaken,and this was used to guide development of indicators, ensuring that new indicators would reflectbest available evidence. National policy and relevant national guidelines, as well as evidence oflocal performance and evaluations of relevant Local Enhanced Services (LES) schemes, includingthe Hammersmith and Fulham CVD Primary Prevention LES and the Lewisham Alcohol LES(Mookherjee, 2007), were used to inform the process. A database of national and London-basedLES schemes was created by the group which acted as an additional resource for indicatordevelopment. Consultation also took place with recognised national and international experts inselected indicator areas including alcohol and data quality (records), and with relevant localservices including the Hammersmith and Fulham Drug and Alcohol Team. The process of indicatordevelopment was also informed by the QOF evidence-based reports produced by the NationalPrimary Care Research and Development Centre (National Primary Care Research andDevelopment Centre, 2008). These reports were generated by the nationwide call for evidence tohealth professionals and patient groups in Spring 2007 and published evidence base. Each reportand its associated set of indicators was “commented on by members of the Royal College ofGeneral Practitioners Patient Participation Group and IT experts to ensure that proposedindicators made sense to patients and would work within primary care IT systems” (NationalPrimary Care Research and Development Centre, 2008).Proposed new QOF+ indicators were discussed at regular face-to-face QOF+ development groupmeetings and through email between group members, in order to further revise and refine them.An evidence-based “QOF+ Report” on each indicator was produced. This was modelled on theevidence-based reports produced as part of the national QOF process, and incorporated similarheadings (where appropriate) including proposed indicators, background, priority and relevanceto national policy, prevalence of condition, associated morbidity and mortality, review ofevidence, degree of perceived professional consensus, degree of perceived support from patientsand carers, health impact, and workload and implications for primary care. Additional categoriesrelating to local context, impact on health inequalities and training implications for primary carewere also included.During the final few months prior to launch of the QOF+ scheme, the Department of Healthannounced a number of new Directed Enhanced Services (DES), which include Alcohol andEthnicity (NHS Employers, 2008). In light of this, the alcohol and ethnicity indicators for QOF Pluswere reviewed and revised to ensure they were in line with the DES, and this process wasfacilitated by discussions with national and international experts in these areas.134
Consultation with local practicesLocal practices were consulted on the proposed QOF+ Scheme including the proposed new QOF+indicators. This consultation process took place through a face-to face meeting with primary careteams (GPs, practice managers and practice nurses) and through consultation conducted throughemail.Assessment of new indicatorsCampbell et al. (2003) comment that “although it may never be possible to produce an error- freemeasure of quality, measures should be tested during their development and application foracceptability, feasibility, reliability, sensitivity to change, and validity. This will optimise theireffectiveness in quality improvement strategies. Marshall et al. (2002) highlight the role ofconsensus techniques in facilitating quality improvement.Proposed new indicators were assessed using the OECD (Organisation for Economic Co-operationand Development) criteria of importance, scientific soundness and feasibility as defined below(Marshall et al., 2004). Each indicator was also assessed for clarity.Scientific Soundness refers to the extent to which you believe that each indicator makes senselogically and clinically, and captures meaningful aspects of the quality of care.Importance refers to the extent to which you believe that each indicator is important formeasuring the quality of primary care. The following dimensions were taken into account whenevaluating each indicator:Impact on healthDoes the indicator address areas in which there is a clear gap between the actual andpotential levels of health?Policy importance. Are policymakers and the general public concerned about this area?Susceptibility to being influenced by primary care. Can the primary health care systemmeaningfully address the aspect or problem being measured by the indicator?Feasibility refers to the extent to which you believe that each indicator is feasible in primary care,and to what extent you believe that the value of the information contained in each indicatoroutweighs the cost of data collection and reporting.Clarity refers to the extent to which you believe that each indicator is expressed in clear, preciseand unambiguous language.Members of the QOF+ Development Group assessed the indicators in terms of importance. Theassessment of feasibility and clarity of indicators was also informed by consultation with local andnational experts in the proposed indicator areas, including the local Professional and ExecutiveCommittee, Clinical lead for Child Protection, the Hammersmith and Fulham TB Action Group, thelocal Drug and Alcohol Team, Professor Richard Baker and Professor Colin Drummond. Changeswere made to the wording of some indicators as a result.135
- Page 103: ReferencesBaker, R (2007) Quality a
- Page 106 and 107: BackgroundThe United Nations Conven
- Page 108 and 109: In March 2008, a PCT audit of signi
- Page 110 and 111: Impact on health inequalitiesPovert
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- Page 114 and 115: Information on self-directed online
- Page 116 and 117: New patient screeningProposed train
- Page 118 and 119: Patient experienceLearning disabili
- Page 120 and 121: Appendix 1Background to the QOF+ de
- Page 122 and 123: Appendix 2Methodology for the exten
- Page 124 and 125: PrevalenceRegistersizeAsthma 5.75%
- Page 126 and 127: While both threshold types are remu
- Page 128 and 129: The low level of remuneration for c
- Page 130 and 131: Exception reportingMany QOF (and a
- Page 132 and 133: indicators compared to national rat
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- Page 136 and 137: Appendix 3Current levels of attainm
- Page 138 and 139: Percentage of practices at or below
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- Page 160 and 161: Appendix 5Methodology for the devel
- Page 162 and 163: Appendix 6Summary of the QOF+ schem
Consultation with local practicesLocal practices were consulted on the proposed <strong>QOF</strong>+ Scheme including the proposed new <strong>QOF</strong>+indicators. This consultation process took place through a face-to face meeting with primary careteams (GPs, practice managers and practice nurses) and through consultation conducted throughemail.Assessment of new indicatorsCampbell et al. (2003) comment that “although it may never be possible to produce an error- freemeasure of quality, measures should be tested during their development and application foracceptability, feasibility, reliability, sensitivity to change, and validity. This will optimise theireffectiveness in quality improvement strategies. Marshall et al. (2002) highlight the role ofconsensus techniques in facilitating quality improvement.Proposed new indicators were assessed using the OECD (Organisation for Economic Co-operationand Development) criteria of importance, scientific soundness and feasibility as defined below(Marshall et al., 2004). Each indicator was also assessed for clarity.Scientific Soundness refers to the extent to which you believe that each indicator makes senselogically and clinically, and captures meaningful aspects of the quality of care.Importance refers to the extent to which you believe that each indicator is important formeasuring the quality of primary care. The following dimensions were taken into account whenevaluating each indicator:Impact on healthDoes the indicator address areas in which there is a clear gap between the actual andpotential levels of health?Policy importance. Are policymakers and the general public concerned about this area?Susceptibility to being influenced by primary care. Can the primary health care systemmeaningfully address the aspect or problem being measured by the indicator?Feasibility refers to the extent to which you believe that each indicator is feasible in primary care,and to what extent you believe that the value of the information contained in each indicatoroutweighs the cost of data collection and reporting.Clarity refers to the extent to which you believe that each indicator is expressed in clear, preciseand unambiguous language.Members of the <strong>QOF</strong>+ Development Group assessed the indicators in terms of importance. Theassessment of feasibility and clarity of indicators was also informed by consultation with local andnational experts in the proposed indicator areas, including the local Professional and ExecutiveCommittee, Clinical lead for Child Protection, the Hammersmith and Fulham TB Action Group, thelocal Drug and Alcohol Team, Professor Richard Baker and Professor Colin Drummond. Changeswere made to the wording of some indicators as a result.135
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