QOF Plus Year 1 - Imperial College London

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Degree of perceived professional consensusCVD risk assessment is supported by professional organisations including the British HeartFoundation, the Joint British Societies and the National Obesity Forum, and by guidelinesincluding JBS-2, SIGN and NICE.A consultation with local stakeholders, including representatives from primary care and publichealth, showed overall consensus for the scientific soundness, importance and feasibility of theseindicators in <strong>QOF</strong>+.Degree of perceived support from patients and carersThere is support for the principles of primary prevention of CVD from a number of patientorganisations including Diabetes UK, the Stroke Association and the British Heart Foundation.Impact on health inequalitiesThose in economically and socially disadvantaged groups and certain ethnic minority groups areat increased risk of CVD. Focussing on primary prevention of CVD in high-risk patients may help toreduce this inequality (Cooper et al., 2008).Health impactPatients may benefit through reduced cardiovascular risk leading to improved life expectancy.Potential harms to patients include iatrogenic effects such as medication side-effects andmedicalisation, leading to negative psychological consequences of having a medical label.24
Workload and training implicationsIncreased workload for primary care teams will be a key issue. This workload will result from theinformation gathering process and the increased contact between primary care practitioners andpatients identified at increased CVD risk. In the long term, there may be a possible reduction inworkload as the identification and management of patients at increased CVD risk may lead toreduced presentation of problems at a later stage.General practice records are now universally computerised and are likely to contain much of theinformation necessary to generate a prior estimate of cardiovascular risk based on existing data(e.g. smoking status, blood pressure and serum lipid profiles) in a high proportion of people(Hobbs et al., 2007). Missing data can be estimated from age- and sex-specific values drawn frompopulation surveys (Marshall, 2006), and automated computer-based risk calculators could beintroduced.The NICE Guideline on Lipid Modification (Cooper et al., 2008) suggests that “using therecommended CVD risk equations, a prior estimate of CVD risk based on pre-existing informationcan be obtained and the practice population can be ranked from highest to lowest risk.” It isproposed that Oberoi software is used to generate a CVD At-Risk Register, using a systematicstrategy to identify asymptomatic people between the ages of 32-74 without diabetes andwithout CVD but who are likely to have a high (20% or greater) 10-year risk of developing CVD(formally estimated through computerized Framingham 1991 10-year risk equations, using CVDrisk factors already documented in their primary care medical records). Starting with those athighest risk, the practice would then invite people to attend for a formal clinical assessment andrisk factor estimation based on the measurement of blood pressure, lipids and current smokingstatus and taking account of other relevant factors such as family history, ethnicity and social orclinical circumstances. Training will be required for primary care staff in cardiovascular riskassessment and communication of risk. The practice will retain responsibility for the creation ofthe CVD at-risk register, which will be dynamic and will require continual updating. However,additional PCT support for this process will be available.In order to evaluate the inclusion in <strong>QOF</strong>+ of indicators relating to CVD primary prevention, it isimportant for practices to submit anonymised data for this purpose (e.g. uptake of screening byage group, sex, ethnic group, deprivation etc; distribution of risk factors by patient group;changes in risk factors over time; economic appraisal). For details of the proposed training package see section 14.3.1 (p92).25
Page 1: Towards world class healthcare for
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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
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Page 43: achieved through primary prevention
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Page 55 and 56: Local context24% of adults (35,000)
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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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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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