QOF reduces admissions - or does it?

I like to be positive here. It is nice to find positive things about the QOF. I was very interested to see reports that higher QOF scores in asthma were associated to a reduction in emergency asthma admissions. Good news - or was it?

The original report (1.7M pdf) was produced by Asthma UK. The report, to be fair, is a glossy affair putting a political message rather than a scientific paper. There are virtually no figures, although some, partially processed, have been put in a couple of appendices. There are some graphs but even these do not seem to support some of the conclusions given.

There is undoubtedly a great variation in the number of emergency admissions with asthma. The greatest factor appears to be latitude with the number going up as you go north and pages six and seven make this clear. So far, so good. There is then a brief pause for a full page photograph of a nurse clinging to a bag and mask and a name and shame list for PCTs. The high admitters tend to be city PCTs and the lower admitters leafy southern PCTs, a fact not commented on. The next page is titled "Why the Divide?". It starts with the sentence The difference in hospital admissions across England is unlikely to reflect differences in the number of people with asthma.. Asthma UK appears to be saying, without offering any real justification that the number of people admitted with asthma is unrelated to the number of people with asthma. Intuitively it seems incredible and unfortunately no evidence if given to back up this bold statement. In fact it is printed above a graph showing pretty much the opposite.

Lastly we get to the correlation with QOF points. There certainly seems to be a weak correlation between QOF score and asthma admissions in 2004/6 - the first year of QOF. This may be something of an underestimate as they use QOF score rather than total QOF achievement. Why should that make a difference? Well QOF scores are capped at 70%. Any extra achievement above this is not counted. In 2004/5 over a third of practices got every single point in the asthma section of QOF. The extra achievement of these practices has been thrown away in the analysis.

In any event all that we can say is there is a correlation. Cause and effect is impossible to suggest without at least some data from previous years.

I would love to see some data that QOF is making a difference. I was disappointed that this report shows little other than a large variation in asthma admission around the country. It does not answer the questions of why half as well as proper peer reviewed study (no mention of QOF though!).

Prevalence data for England and Northern Ireland

Prevalence data is starting to get out! In the table below you can see the data from England and Northern Ireland. The English data was taken from QMAS at the start of April and the NI data from their official prevalence bulletin. I would recommend the NI bulletin for further reading as there are a lot of nice charts showing the spread of the prevalence. When comparing the data with previous years it is important to remember that there have been big rule changes in mental health and smaller one in LVD. Also of note is that the palliative care prevalence is for information only and does not change the cash value of points as the others do.

There are couple of figures in the NI bulletin I don't understand - mainly the depression 2 and LVD 3 listings. I can't quite see the relevance but I will ask!

Prevalence Area England Northern Ireland
CHD 3.551 4.196
LVD 0.790 0.818
Stroke 1.615 1.619
Hypertension 12.466 11.651
Diabetes 3.629 3.138
COPD 1.425 15.33
Epilepsy 0.590 0.745
Thyroid 2.490 2.872
Cancer 0.897 0.778
Palliative Care 0.087 0.090
Mental Health 0.716 0.753
Asthma 5.771 5.78
Dementia 0.400 0.526
Depression* 7.004 6.5
Kidney Disease 2.242 2.307
Atrial Fibrillation 1.295 1.252
Obesity 7.223 7.989
Learning disabilities 0.256 0.316
Smoking - for recording** 19.557 18.55

* I am not sure exactly what this depression figure means. I think it is the number of people eligible for depression screening.

** This is the number of people eligible to be asked regularly about their smoking. It is the combined prevalence of diabetes, hypertension, heart disease, COPD and stroke