The UK Quality and Outcomes Framework pay-for-performance scheme and spirometry: rewarding quality or just quantity A cross-sectional study in Rotherham, UKReport as inadecuate




The UK Quality and Outcomes Framework pay-for-performance scheme and spirometry: rewarding quality or just quantity A cross-sectional study in Rotherham, UK - Download this document for free, or read online. Document in PDF available to download.

BMC Health Services Research

, 9:108

First Online: 28 June 2009Received: 06 February 2009Accepted: 28 June 2009DOI: 10.1186-1472-6963-9-108

Cite this article as: Strong, M., South, G. & Carlisle, R. BMC Health Serv Res 2009 9: 108. doi:10.1186-1472-6963-9-108

Abstract

BackgroundAccurate spirometry is important in the management of COPD. The UK Quality and Outcomes Framework pay-for-performance scheme for general practitioners includes spirometry related indicators within its COPD domain. It is not known whether high achievement against QOF spirometry indicators is associated with spirometry to BTS standards.

MethodsData were obtained from the records of 3,217 patients randomly sampled from 5,649 patients with COPD in 38 general practices in Rotherham, UK. Severity of airflow obstruction was categorised by FEV1 % predicted according to NICE guidelines. This was compared with clinician recorded COPD severity. The proportion of patients whose spirometry met BTS standards was calculated in each practice using a random sub-sample of 761 patients. The Spearman rank correlation between practice level QOF spirometry achievement and performance against BTS spirometry standards was calculated.

ResultsSpirometry as assessed by clinical records was to BTS standards in 31% of cases range at practice level 0% to 74%. The categorisation of airflow obstruction according to the most recent spirometry results did not agree well with the clinical categorisation of COPD recorded in the notes Cohen-s kappa = 0.34, 0.30 – 0.38. 12% of patients on COPD registers had FEV1 % predicted results recorded that did not support the diagnosis of COPD. There was no association between quality, as measured by adherence to BTS spirometry standards, and either QOF COPD9 achievement Spearman-s rho = -0.11, or QOF COPD10 achievement rho = 0.01.

ConclusionThe UK Quality and Outcomes Framework currently assesses the quantity, but not the quality of spirometry.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-9-108 contains supplementary material, which is available to authorized users.

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Author: Mark Strong - Gail South - Robin Carlisle

Source: https://link.springer.com/



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