The role of the Quality and Outcomes Framework in the care of long-term conditions: a systematic review

Forbes, Lindsay JL and Marchand, Catherine and Doran, Tim and Peckham, Stephen (2017) The role of the Quality and Outcomes Framework in the care of long-term conditions: a systematic review. British Journal of General Practice, 67 (664). e775-e784. ISSN 0960-1643. (doi:https://doi.org/10.3399/bjgp17X693077) (Full text available)

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https://doi.org/10.3399/bjgp17X693077

Abstract

Background Improving care for people with long-term conditions is central to NHS policy. It has been suggested that the Quality and Outcomes Framework (QOF), a primary care pay-for-performance scheme that rewards practices for delivering effective interventions in long-term conditions, does not encourage high-quality care for this group of patients. Aim To examine the evidence that the QOF has improved quality of care for patients with long-term conditions. Design and setting This was a systematic review of research on the effectiveness of the QOF in the UK. Method The authors searched electronic databases for peer-reviewed empirical quantitative research studying the effect of the QOF on a broad range of processes and outcomes of care, including coordination and integration of care, holistic and personalised care, self-care, patient experience, physiological and biochemical outcomes, health service utilisation, and mortality. Because the studies were heterogeneous, a narrative synthesis was carried out. Results The authors identified three systematic reviews and five primary research studies that met the inclusion criteria. The QOF was associated with a modest slowing of both the increase in emergency admissions and the increase in consultations in severe mental illness (SMI), and modest improvements in diabetes care. The nature of the evidence means that the authors cannot be sure that any of these associations is causal. No clear effect on mortality was found. The authors found no evidence that the QOF influences integration or coordination of care, holistic care, self-care, or patient experience. Conclusion The NHS should consider more broadly what constitutes high-quality primary care for people with long-term conditions, and consider other ways of motivating primary care to deliver it.

Item Type: Article
Uncontrolled keywords: incentive reimbursement, primary health care, quality indicators, health care, quality of health care
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research
Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Stephen Peckham
Date Deposited: 05 Oct 2017 09:55 UTC
Last Modified: 23 Nov 2017 12:16 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/63804 (The current URI for this page, for reference purposes)
Peckham, Stephen: https://orcid.org/0000-0002-7002-2614
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