Measuring Prevalence

One of the questions often asked by GPs about QOF data is what their prevalence data should be. There are three ways to measure the prevalence of a condition. First you can ask doctors, second ask patients and thirdly you can get out there and thoroughly examine a random group of people.

The data from QOF on this site is definitely in the first camp. I have come across some interesting disease prevalence models which try to compare QOF data against data from the Health Survey for England which is largely, as the name suggests a survey of the asking patients variety. It does however features some objective measurement by nurses as well.

There is only analysis for heart disease and hypertension. In heart disease there is a small reduction in prevalence in QOF compared to the HSE estimation. This is probably down to a lack of coding. The differences in hypertension prevalence are much larger with the HSE prevalence over double the QOF prevalence.

Now I have to admit that I boggled at this for a while. Could it really be that a quarter of all my patients had hypertension? Well the answer by strict interpretation seems to be "Yes". In fact the data, including the difference between the diagnosed and the actively treated has been observed for some time.

Now I don't propose to go through the rights and wrongs of this but the fact remains that prevalence varies widely possibly predictably depending who you ask. We don't have the official figures for this year's prevalence but kidney disease seems certain to come in well under expectations.

So before making comparisons make sure that data is all coming from the same sources. We await the official figures (traditionally Wales has been early with them but not this year).

Waiting for the Data

So far this month the data has been submitted to QMAS - which stumbled and recovered a couple of days later. PCTs should have received the final data and I have had a short holiday.

I came back from my holiday to an email asking about the status of the data currently showing on QMAS. This is not available to the public as yet as it has not been finalised. We can expect the final data, for England at least, around September. I can see from emails and server logs however that many users of this site work in the NHS itself and so may have access to the QMAS data. Can it be relied upon?

It is useful to know the stages the data passes through. Data from practices should have been signed off on QMAS by now. The signing of process signifies the agreement with the submitted data by the practice and the guidance describes it as a legal declaration that the submission is accurate. In the vast majority of cases this will lead directly to payment without further changes, often within a few weeks.

In some cases there is disagreement from the PCT, most often querying a claim. This normally relates to some disagreement over the interpretation of an indicator although occasionally it may be used to customise QOF to some local and special circumstance - particularly in the clinical areas where the data is automatically extracted. It is this process which must be completed by June, although it is rare that it takes this long.

In any case PCTs should be aware by now of any disputed figures. If you are working in the PCT it is hopefully a simple matter to find out who is dealing with these disputes, make them a coffee and ask if they are aware of any possible changes to the data. If there is no dispute the data can probably be considered as final.

The rest of us will just have to wait.

QMAS trips up

Now if there was one thing that seemed to be reliable in the new work of NHS IT it was the QMAS computer. It was hailed as a great success by Connecting For Health. It was an early win. Yes, it wasn't in their original brief and it was not an especially complex system, but it did have over 10,000 users and it worked well. Until today.

There have been no problems for the last two years but today it has failed under load for much of the day. Nine thousand practices are trying to sign off their data. All this has snowballed for the simple reason that the more error reports that are sent, the more people press OK. Users are also managing to lock themselves out of the system.

In terms of getting data published there should not be a significant delay, but the timetables for payment are a lot tighter. We can hope for a better day tomorrow and perhaps an explanation of why it worked well for two years and then went wrong today. Now if I can just get my Glastonbury tickets..