QOF Plus Year 1 - Imperial College London

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Continued…QOFQOF+IndicatorUpperThresholdThreshold& (Tolerance) †PointsDM 17. The percentage of patients withdiabetes whose last measured total cholesterolwithin the previous 15 months is ≤5mmol/lDM 20. The percentage of patients withdiabetes in whom the last HBA1c is 7.5 or less inthe previous 15 monthsMH 6. The percentage of patients on theregister who have a comprehensive care plandocumented in the records agreed betweenindividuals, their family and/or carers asappropriateSTROKE 6. The percentage of patients with ahistory of TIA or stroke in whom the last bloodpressure reading (measured in the previous 15months) is ≤150/90 in the previous 15 monthsSTROKE 8. The percentage of patients with ahistory of TIA or stroke in whom the last totalcholesterol (measured in the previous 15months) is 5 mmol/l or less70% 88% (1%) 950% 77% (1%) 2050% 97% (1%) 370% 96% (1%) 660% 85% (1%) 5Under the current QOF 2009/10 proposal, DM20 will be replaced by DM23, which lowersthe target for HbA1c to ≤7.0. We recognise that attaining this more aggressive target willrequire significant effort involving potentially large numbers of patients. To rewardpractices as they progress towards the revised goal, we propose to retain DM20 withinQOF+ until the end of March 2010. Since DM20 attainment status will no longer beavailable through QMAS, feedback will instead be provided through the same mechanismof monthly reporting used for the new QOF+ clinical indicators.† During consultation with practices concern was raised about the possibility, with an ‘allor-nothing’payment mechanism, of receiving no remuneration where the revised targetwas missed through accidental failures involving small numbers of patients. A range ofsolutions were considered to address this – including the use of payment ranges, similarto those of QOF – but all were felt to distract from a key aim of the revised targets, whichis to drive performance towards the best seen at a national level. It was decided to retainthe single upper threshold but to introduce a tolerance (bracketed figures in the tableabove) which lowers the threshold by the specified amount. Attainment lying at or abovethis lower figure will be remunerated by receiving half the available points. Where thepoint number is odd, the points will be divided unequally with the balance in favour ofthe tolerance payment. The existing 3-month exemption for newly registered patientswill be respected across these and the newly introduced indicators.10
New clinical QOF+ indicatorsNew indicators are distinguished from existing QOF targets by the plus (+) prefix. Blanketminimum attainment thresholds will no longer be included in year 1 of the QOF+ scheme (for more information see Appendix 2, Section A2.4). Point awards will be based on attainment atclose of business on November 30 2009.Cardiovascular disease prevention Chapter 3 (p19)IndicatorQOF+pointsPaymentstages+ CVD PREVENT 1. The percentage of patients on the PracticeCVD At-Risk Register whose notes have a Blood Pressurerecorded in the previous 17 months+ CVD PREVENT 2. The percentage of patients on the PracticeCVD At-Risk Register whose notes have a record of BMImeasured in the previous 17 months+ CVD PREVENT 3. The percentage of patients on the PracticeCVD At-Risk Register whose notes have a baseline record oftotal and HDL cholesterol recorded in the previous 17 months+ CVD PREVENT 4. The percentage of patients on the PracticeCVD At-Risk Register for whom there is a record of a fastingblood glucose in the previous 17 months+ CVD PREVENT 5. The percentage of patients on the PracticeCVD At-Risk Register whose notes have a record of familyhistory of CHD in first degree relatives (parents, brothers,sisters, or children of a patient)+ CVD PREVENT 6. The percentage of patients on the PracticeCVD At-Risk Register whose notes have a record of familyhistory of diabetes in first degree relatives (parents, siblings,or children of a patient)+ CVD PREVENT 7. The percentage of patients on the PracticeCVD At-Risk Register who have been offered lifestyle advice onexercise, and appropriate dietary changes within the previous17 months+ CVD PREVENT 8. The percentage of patients on the PracticeCVD At-Risk Register who have been offered statin therapy (inline with 2008 NICE guidance on Lipid Modification) as part oftheir primary prevention management strategy8 40-90%8 40-90%8 40-90%8 40-90%8 40-90%8 40-90%10 40-90%10 40-90%It is prerequisite that in order to receive payment for + CVD PREVENT 1, practices have achievedthe existing QOF RECORDS 11 Indicator (The BP of patients aged 45 and over is recorded in thepreceding 5 years for at least 65% of patients.)11
Page 1: Towards world class healthcare for
Page 6 and 7: QOF+ report on breastfeeding ......
Page 8 and 9: QOF+ report on patient safety .....
Page 10 and 11: CreditsProject boardJosip CarMiles
Page 12: AcknowledgementsWe are indebted to
Page 15 and 16: Executive summaryIntroductionPrevio
Page 18: Support with QOF+If you have a prob
Page 22 and 23: The quality and outcomes framework
Page 24 and 25: Effect of measurement on health ine
Page 26 and 27: How might a local QOF operate in pr
Page 28 and 29: Doran T, Fullwood C, Kontopantelis
Page 32 and 33: Alcohol Chapter 4 (p27)IndicatorQOF
Page 34 and 35: RecordsIndicator+ PRESCRIPTION 1. T
Page 36 and 37: Patient experience Chapter 12 (p77)
Page 39 and 40: C3QOF+ report on cardiovasculardise
Page 41 and 42: Creation of practice CVD at-risk re
Page 43 and 44: achieved through primary prevention
Page 45 and 46: Workload and training implicationsI
Page 47 and 48: QOF+ report on alcoholProposed indi
Page 49 and 50: Local contextThe Hammersmith and Fu
Page 51 and 52: Workload and training implicationsR
Page 53 and 54: QOF+ report on smokingProposed indi
Page 55 and 56: Local context24% of adults (35,000)
Page 57: ReferencesBritish Medical Associati
Page 60 and 61: The NICE Clinical Guideline on Ante
Page 62 and 63: Health impactThere are significant
Page 65 and 66: QOF+ report on breastfeedingPropose
Page 67 and 68: Local contextIn 2006/7, the percent
Page 69 and 70: Degree of perceived professional co
Page 71 and 72: QOF+ report on ethnicityProposed In
Page 73 and 74: Associated Morbidity and MortalityT
Page 75: Workload and training implicationsP
Page 78 and 79: Priority and relevance to national
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Specific reasons for this framework
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Workload and training implicationsT
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QOF+ report on newpatient screening
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Review of evidence to support the p
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QOF+ report onpatient informationPr
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Priority and relevance to national
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Degree of perceived support from pa
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ReferencesCarpenter A and Mayers A
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QOF+ report onpatient experiencePro
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Rosen et al. (2001) categorised ini
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The National 2007 Quality and Outco
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ReferencesBaker, R (2007) Quality a
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BackgroundThe United Nations Conven
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In March 2008, a PCT audit of signi
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Impact on health inequalitiesPovert
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Training and support requirements f
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Information on self-directed online
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New patient screeningProposed train
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Patient experienceLearning disabili
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Appendix 1Background to the QOF+ de
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Appendix 2Methodology for the exten
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PrevalenceRegistersizeAsthma 5.75%
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While both threshold types are remu
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The low level of remuneration for c
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Exception reportingMany QOF (and a
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indicators compared to national rat
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114
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Appendix 3Current levels of attainm
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Percentage of practices at or below
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Appendix 4Methodology for the desig
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As a result of the prioritisation p
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Methodology for the development of
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Assessment of new clinical and reco
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Communication with the PCT’s heal
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Appendix 5Methodology for the devel
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Appendix 6Summary of the QOF+ schem
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QOF Plus Year 1 - Imperial College London

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